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Lumbar Discectomy: A National Survey of Neurosurgeons and Literature Review

Published online by Cambridge University Press:  02 December 2014

Aleksa Cenic  and
Edward Kachur
Aleksa Cenic
Affiliation:
Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
Edward Kachur*
Affiliation:
Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
*
Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario, L8L 2X2, Canada
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Abstract

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Background:

To ascertain neurosurgical practices in the surgical management of one-level lumbar discectomies in the Canadian adult population.

Methods:

One page questionnaire faxed to each Neurosurgeon in Canada with questions relating to their practice in the management of this common neurosurgical procedure. All data analyzed using Chi-square statistics.

Results:

112 completed surveys were returned hence, giving a 64% response rate with the respondents being predominantly adult neurosurgeons. Of the respondents, 88% perform lumbar discectomy in adults. Only 15% of respondents had a Spine Fellowship. For preoperative imaging, 44% use BOTH CT and MRI whereas 28% use only MRI and 15% use only CT. Prior to initial skin incision, 57% use a localization X-ray image. Preoperative antibiotics are prescribed by 92% of respondents. Majority of respondents (60%) use a pre-incision local anesthetic, whereas only a minority (44%) of respondents employ pre-closure intramuscular injection. With respect to magnification, 70% use microscope, 19% loupes, and 8% neither. Only 12% use minimally invasive tubular retractors. 68% remove “as much disc as possible”, while 31% remove “ONLY herniated part”. In the case of dural tears, 77% of respondents use fibrin glue (Tisseel®). Prior to skin closure, majority of neurosurgeons do NOT use a fat graft (72%), whereas 61% of respondents use epidural steroids. With respect to discharge from the hospital, 58% are discharged on the next day, 18% on the same day, and 23% in two days. Return to work is not recommended until at least six weeks post-op (96%). Most neurosurgeons (93%) would not operate on an individual with a chief complaint of low back pain.

Conclusions:

Our survey has identified variations in practice patterns amongst Canadian Neurosurgeons with respect to performing one-level lumbar discectomies. This survey is expected to form a basis for the design of a randomized controlled trial in the evaluation of the best management approach for this common neurosurgical procedure.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 36 , Issue 2 , March 2009 , pp. 196 - 200
Copyright
Copyright © The Canadian Journal of Neurological 2009

References

1.Hanley, E.Surgical indications and techniques. The International Society for the Study of the Lumbar Spine. The lumbar spine, 2nd ed. Philadelphia: WB Saunders; 1996. p. 492–524.Google Scholar
2.Frizzell, RT, Hadley, MN.Lumbar microdiscectomy with medial facetectomy. Techniques and analysis of results. Neurosurg Clin N Am. 1993 Jan;4(1):109–15.CrossRefGoogle ScholarPubMed
3.Barker, FG.Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis. Neurosurgery. 2002 Aug;51(2): 391–400.Google Scholar
4.Schnoring, M, Brock, M.Prophylactic antibiotics in lumbar disc surgery: analysis of 1,030 procedures. Zentralbl Neurochir. 2003;64(1):24–9.Google Scholar
5.Mullen, JB, Cook, WA.Reduction of postoperative lumbar hemilaminectomy pain with Marcaine. Technical note. J Neurosurg. 1979 Jul;51(1):126–7.CrossRefGoogle ScholarPubMed
6.Ersayli, DT, Gurbet, A, Bekar, A, Uckunkaya, N, Bilgin, H.Effects of perioperatively administered bupivacaine and bupivacainemethylprednisolone on pain after lumbar discectomy. Spine. 2006 Sep 1 31;(19):2221–6.Google Scholar
7.Hernandez-Palazon, J, Tortosa Serrano, JA, Burguillos Lopez, S, Molero Molero, E.Infiltration of the surgical wound with local anesthetic for postoperative analgesia in patients operated on for lumbar disc herniation. Comparative study of ropivacaine and bupivacaine. Rev Esp Anestesiol Reanim. 2001 Jan;48(1):17–20.Google ScholarPubMed
8.Milligan, KR, Macafee, AL, Fogarty, DJ, Wallace, RG, Ramsey, P.Intraoperative bupivacaine diminishes pain after lumbar discectomy. A randomized double-blind study. J Bone Joint Surg Br. 1993 Sep;75(5):769–71.CrossRefGoogle Scholar
9.Thome, C, Barth, M, Scharf, J, Schmiedek, P.Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study. J Neurosurg Spine. 2005 Mar;2(3):271–8.CrossRefGoogle ScholarPubMed
10.Carragee, EJ, Spinnickie, AO, Alamin, TF, Paragioudakis, S.A prospective controlled study of limited versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumbar intervertebral discs and large posterior anular defect. Spine. 2006 Mar 15 31;(6):653–7.CrossRefGoogle ScholarPubMed
11.Schizas, C, Tsiridis, E, Saksena, J.Microendoscopic discectomy compared with standard microsurgical discectomy for treatment of uncontained or large contained disc herniations. Neurosurgery. 2005 Oct;57(4 Suppl):357–60; discussion 357-60.Google ScholarPubMed
12.Wu, X, Zhuang, S, Mao, Z, Chen, H.Microendoscopic discectomy for lumbar disc herniation: surgical technique and outcome in 873 consecutive cases. Spine. 2006 Nov 1;31(23):2689–94.CrossRefGoogle ScholarPubMed
13.Perez-Cruet, MJ, Foley, KT, Isaacs, RE, Rice-Wyllie, L, Wellington, R, Smith, MM, et al.Microendoscopic lumbar discectomy: technical note. Neurosurgery. 2002 Nov;51(5 Suppl):S129–36.Google Scholar
14.Jensen, TT, Asmussen, K, Berg-Hansen, EM, Lauritsen, B, Manniche, C, Vinterberg, H, et al.First-time operation for lumbar disc herniation with or without free fat transplantation. Prospective triple-blind randomized study with reference to clinical factors and enhanced computed tomographic scan 1 year after operation. Spine. 1996 May 1;21(9):1072–6.CrossRefGoogle ScholarPubMed
15.Gorgulu, A, Simsek, O, Cobanoglu, S, Imer, M, Parsak, T.The effect of epidural free fat graft on the outcome of lumbar disc surgery. Neurosurg. Rev. 2004 Jul;27(3):181–4.CrossRefGoogle ScholarPubMed
16.Bernsmann, K, Kramer, J, Ziozios, I, Wehmeier, J, Wiese, M.Lumbar micro disc surgery with and without autologous fat graft. A prospective randomized trial evaluated with reference to clinical and social factors. Arch Orthop Trauma Surg. 2001 Sep;121(8): 476–80.CrossRefGoogle Scholar
17.Martin-Ferrer, S.Failure of autologous fat grafts to prevent postoperative epidural fibrosis in surgery of the lumbar spine. Neurosurgery. 1989 May;24(5):718–21.Google Scholar
18.Lavyne, MH, Bilsky, MH.Epidural steroids, postoperative morbidity, and recovery in patients undergoing microsurgical lumbar discectomy. J Neurosurg. 1992 Jul;77(1):90–5.Google Scholar
19.Debi, R, Halperin, N, Mirovsky, Y.Local application of steroids following lumbar discectomy. J Spinal Disord Tech. 2002 Aug;15(4):273–6.Google Scholar
20.Lowell, TD, Errico, TJ, Eskenazi, MS.Use of epidural steroids after discectomy may predispose to infection. Spine. 2000 Feb 15; 25(4):516–9.CrossRefGoogle ScholarPubMed
21.Atlas, SJ, Keller, RB, Wu, YA, Deyo, RA, Singer, DE.Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the Maine lumbar spine study. Spine. 2005 Apr 15;30(8):927–35.Google Scholar
22.Pevsner, PH, Ondra, S, Radcliff, W, George, E, McDonnell, D, Furlow, T, et al.Magnetic resonance imaging of the lumbar spine. A comparison with computed tomography and myelography. Acta Radiol Suppl. 1986;369:706–7.Google ScholarPubMed
23.Jackson, RP, Cain, JE, Jacobs, RR, Cooper, BR, McManus, GE.The neuroradiographic diagnosis of lumbar herniated nucleus pulposus: II. A comparison of computed tomography (CT), myelography, CT-myelography, and magnetic resonance imaging. Spine. 1989 Dec;14(12):1362–7.CrossRefGoogle Scholar
24.D’Andrea, G, Trillo, G, Roperto, R, Celli, P, Orlando, ER, Ferrante, L.Intradural lumbar disc herniations: the role of MRI in preoperative diagnosis and review of the literature. Neurosurg Rev. 2004 Apr;27(2):75–80; discussion 81-2. Epub 2003 Oct 15.CrossRefGoogle ScholarPubMed
25.Tafazal, SI, Sell, PJ.Incidental durotomy in lumbar spine surgery: incidence and management. Eur Spine J. 2005 Apr;14(3): 287–90.Google Scholar
26.McCulloch, JA.Complications in lumbar microsurgery. In: Wiliams, RW, McCulloch, JA, Young, PH, editors. Microsurgery of the lumbar spine. Rockville, MD: Aspen; 1990. p. 159–66.Google Scholar
27.Bosacco, SJ, Gardner, MJ, Guille, JT.Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res. 2001 Aug;(389):238–47.CrossRefGoogle ScholarPubMed