Management of Symptomatic Lumbar Disk Herniation

Gadjradj, Pravesh S.; Arts, Mark P.; Tulder, Maurits W. van; Rietdijk, Wim; Peul, Wilco C.; Harhangi, Biswadjiet S.

doi:10.1097/brs.0000000000002294

Cited by 49 publications

(40 citation statements)

References 48 publications

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“…Our survey has several strengths, including its combination of general questions and case studies, which provide valuable insight into the way neurologists and anesthesiologists think. Moreover, surveys on sciatica have been published before, but those were restricted to surgeons [25, 26], whereas ours addresses neurologists and anesthesiologists.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Sciatica in the Netherlands: A Survey among Neurologists and Anesthesiologists

Meulen

Overweg²,

Feenstra³

et al. 2021

Eur Neurol

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Background: This study aimed to assess how Dutch neurologists and anesthesiologists diagnose and treat people with sciatica in secondary care and to evaluate their adherence to the newest guidelines. Methods: We conducted a cross-sectional survey. Respondents were asked about their current clinical practice related to sciatica. Three authors rated the respondents’ adherence to the guidelines on a three-point Likert scale. Results: Eighty neurologists and 44 anesthesiologists completed the questionnaire. Neurologists diagnose their sciatica patients primarily using a magnetic resonance imaging (89%). Selective diagnostic nerve blocks are considered useful by 81% of the neurologists. Neurologists primarily treat patients with pain medication, and 40% of them think epidural steroid injections are effective in 40–60% of injected patients. Twenty-nine percent of neurologists refer patients to a neurosurgeon after 4 months. Anesthesiologists consider a selective diagnostic nerve root block to have a higher diagnostic value than mapping. The most reported side effect of epidural injections is exacerbation of pain (82%). Pulse radiofrequency is applied in 9–11% of acute cases. The results also indicate that Dutch neurologists and anesthesiologists follow an evidence-based approach that is strictly or broadly in line with the guideline. Conclusions: Neurologists treat sciatica patients initially with pain medication and physiotherapy, followed by epidural steroid injections and referral for surgery. Anesthesiologists treat sciatica patients with one or more steroid injections or may perform a selective nerve root block. Imaging, selective nerve root blocks, medication, physiotherapy, and pulse radiofrequency are topics of further research.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Sciatica in the Netherlands: A Survey among Neurologists and Anesthesiologists

Meulen

Overweg²,

Feenstra³

et al. 2021

Eur Neurol

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“…The majority of patients improve spontaneously during the first few weeks or months. However, in some patients symptoms persist or progress after 4−12 weeks of nonsurgical care, and these patients should be referred to a spine surgeon for a possible discectomy [1].…”

Section: Introductionmentioning

confidence: 99%

Return to work after surgery for lumbar disc herniation, secondary analyses from a randomized controlled trial comparing supervised rehabilitation versus home exercises

et al. 2020

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“…For instance, partially due to a limited view through an endoscope, PTED might be more difficult to master for surgeons compared to conventional OM [14,20]. Therefore, only a limited number of surgeons may offer full-endoscopic techniques to treat LDH [21]. Another limitation may be the hypothetical nature of the DCE as most choice sets in the survey do not represent actual surgical techniques.…”

Section: Discussionmentioning

confidence: 99%

Surgeons preference for lumbar disk surgery: a discrete choice experiment

Gadjradj¹,

Harhangi

Tulder

et al. 2021

Eur Spine J

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Purpose Multiple surgical techniques are practiced to treat sciatica caused by lumbar disk herniation. It is unknown which factors surgeons find important when offering certain surgical techniques. The objective of this study is threefold: 1) determine the relative weight surgeons place on various characteristics of sciatica treatment, 2) determine the trade-offs surgeons make between these characteristics and 3) identify preference heterogeneity for sciatica treatment. Methods A discrete choice experiment was conducted among members of two international neurosurgical organizations. Surgeons were asked on their preferences for surgical techniques using specific scenarios based on five characteristics: effectiveness on leg pain, risk of recurrent disk herniation, duration of postoperative back pain, risk of complications and recovery period. Results Six-hundred and forty-one questionnaires were filled in, the majority by neurosurgeons. All characteristics significantly influenced the preferences of the respondents. Overall, the risk of complications was the most important characteristic in the decision to opt-in or opt-out for surgery (35.7%). Risk of recurrent disk herniation (19.6%), effectiveness on leg pain (18.8%), postoperative back pain duration (13.5%) and length of recovery period (12.4%) followed. Four latent classes were identified, which was partly explained by the tenure of the surgeon. Surgeons were willing to trade-off 57.8% of effectiveness on leg pain to offer a treatment that has a 1% complication risk instead of 10%. Conclusion In the context of this discrete choice experiment, it is shown that neurosurgeons consider the risk of complications as most important when a surgical technique is offered to treat sciatica, while the risk of recurrent disk herniation and effectiveness are also important factors. Neurosurgeons were prepared to trade off substantial amounts of effectiveness to achieve lower complication rates.

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Management of Symptomatic Lumbar Disk Herniation

Abstract: N/A.

Cited by 49 publications

References 48 publications

Diagnosis and Treatment of Sciatica in the Netherlands: A Survey among Neurologists and Anesthesiologists

Diagnosis and Treatment of Sciatica in the Netherlands: A Survey among Neurologists and Anesthesiologists

Return to work after surgery for lumbar disc herniation, secondary analyses from a randomized controlled trial comparing supervised rehabilitation versus home exercises

Surgeons preference for lumbar disk surgery: a discrete choice experiment

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