de Rooij Judith D, Gadjradj Pravesh S, Huygen Frank J, Luijsterburg Pim A J, Harhangi Biswadjiet S
Department of Neurosurgery, Erasmus MC: University Medical Center Rotterdam, The Netherlands.
Department of Pain Medicine, Erasmus MC: University Medical Center Rotterdam, The Netherlands.
Spine (Phila Pa 1976). 2017 Mar;42(5):311-317. doi: 10.1097/BRS.0000000000001743.
A questionnaire survey.
To assess the preferred surgical technique, the optimal timing of surgery, and the expectations of different surgical techniques of neurosurgeons in the Netherlands, regarding patients with cervical disc herniation (CDH).
To treat CDH, multiple surgical techniques are performed. Due to the lack of consensus, the daily routine management may vary.
All 134 neurosurgeons of the Dutch Association of Neurosurgery were sent a survey, evaluating the operative management as well as the attitude towards different surgical treatments for CDH.
Ninety-six (74.4%) of the neurosurgeons treating CDH completed the survey. Anterior cervical discectomy with fusion (ACDF) was the standard procedure for the majority of neurosurgeons (76.3%). ACDF was expected to have the highest effectiveness on arm pain, yet also a higher risk for complications as compared with anterior cervical discectomy (ACD). Approximately, 47.9% of the surgeons regarded a minimal duration of 8 to 12 weeks of radicular arm pain before deciding to perform surgery. Regarding the risk of recurrent CDH, DCF was expected to give the highest risk, whereas ACDF the lowest.
Despite the lack of solid evidence in favor for ACDF this survey showed that ACDF is the preferred technique to treat cervical radiculopathy. A minimum duration of 8 to 12 weeks of radicular arm pain was considered the optimal timing to perform surgery for CDH by the majority of the neurosurgeons. Whether to fuse or not remains a controversial subject in degenerative spinal surgery. This study emphasizes the need of high-quality evidence on the optimal surgical management of CDH.
N/A.
问卷调查。
评估荷兰神经外科医生对于颈椎间盘突出症（CDH）患者首选的手术技术、最佳手术时机以及对不同手术技术的期望。
治疗CDH有多种手术技术。由于缺乏共识，日常治疗方案可能存在差异。
向荷兰神经外科学会的134名神经外科医生发送调查问卷，评估手术治疗管理以及对CDH不同手术治疗的态度。
治疗CDH的神经外科医生中有96名（74.4%）完成了调查。对于大多数神经外科医生（76.3%）而言，颈椎前路椎间盘切除融合术（ACDF）是标准术式。与颈椎前路椎间盘切除术（ACD）相比，预计ACDF对臂痛的疗效最佳，但并发症风险也更高。约47.9%的外科医生认为在决定手术前神经根性臂痛的最短持续时间为8至12周。关于复发性CDH的风险，预计椎间盘置换融合术（DCF）风险最高，而ACDF风险最低。
尽管缺乏支持ACDF的确凿证据，但本次调查显示ACDF是治疗神经根型颈椎病的首选技术。大多数神经外科医生认为神经根性臂痛持续8至12周是CDH手术的最佳时机。在退行性脊柱手术中是否进行融合仍然是一个有争议的问题。本研究强调了关于CDH最佳手术治疗的高质量证据的必要性。
无。
