Department of Neurosurgery, Erasmus MC: University Medical Center Rotterdam, The Netherlands.
Department of Neurosurgery, Leiden University Medical Center, The Netherlands.
Spine (Phila Pa 1976). 2017 Dec 1;42(23):1826-1834. doi: 10.1097/BRS.0000000000002294.
: The diversity among the current international practice patterns and the discrepancy between the eminence-based medicine and the evidence-based medicine in the treatment of lumbar disk herniation is presented. Minimally invasive techniques were expected to give the lowest postoperative low back pain, however, also to give the highest risk of recurrent disk herniation.
A questionnaire survey.
To evaluate the current practice patterns of surgeons regarding both the surgical and nonsurgical management of lumbar disk herniation (LDH) worldwide and to compare this with the current literature.
Sciatica is a common diagnosis in the general population. Sciatica is most frequently caused by LDH. Multiple surgical techniques and treatment modalities are available to treat LDH, albeit some with small effect sizes or without compelling evidence.
A survey including questions on the application of physical examination, expectations regarding different surgical and nonsurgical techniques, factors influencing the outcome of surgery were distributed among members of AOSpine International and the European Association of Neurosurgical Societies.
Eight hundred and seventeen surgeons from 89 countries completed the questionnaire. These surgeons perform a total of 62.477 discectomies yearly. Pain medication and steroid injections were expected to be the most effective nonsurgical treatments. The severity of pain and/ or disability and failure of conservative therapy were the most important indications for surgery. A period of 1 to 2 months of radiculopathy was regarded as a minimum for indicating surgery. Unilateral transflaval discectomy was the procedure of choice among the majority and was expected to be the most effective technique with the lowest complication risk. Surgeons performing more lumbar discectomies, with more clinical experience and those located in Asia, were more likely to offer minimally invasive surgical techniques.
This study shows that current international practice patterns for LDH surgery are diverse. There seems to be a discrepancy between preferred surgical techniques and the attitudes of surgeons worldwide and the evidence. Further research should focus on developing international guidelines to reduce practice variety and offer patients the optimal treatment for LDH.
N/A.
：目前国际实践模式的多样性以及腰椎间盘突出症治疗中的基于卓越的医学与基于证据的医学之间的差异。微创技术有望带来术后最低的腰痛，但也有最高的椎间盘突出复发风险。
问卷调查。
评估全球外科医生在腰椎间盘突出症（LDH）的手术和非手术治疗方面的当前实践模式，并将其与当前文献进行比较。
坐骨神经痛是普通人群中的常见诊断。坐骨神经痛最常由 LDH 引起。有多种手术技术和治疗方法可用于治疗 LDH，尽管其中一些技术的效果较小或缺乏确凿证据。
一项调查包括对体格检查的应用、对不同手术和非手术技术的期望、影响手术结果的因素等问题，分发给 AOSpine 国际和欧洲神经外科学会协会的成员。
来自 89 个国家的 817 名外科医生完成了问卷。这些外科医生每年总共进行 62477 次椎间盘切除术。疼痛药物和类固醇注射被认为是最有效的非手术治疗方法。疼痛和/或残疾的严重程度以及保守治疗的失败是手术的最重要指征。神经根病持续 1 至 2 个月被认为是手术的最低指征。大多数人选择单侧经椎间孔椎间盘切除术，并且预计这是最有效的技术，并发症风险最低。进行更多腰椎间盘切除术、具有更多临床经验和位于亚洲的外科医生更有可能提供微创手术技术。
本研究表明，目前国际上治疗 LDH 的手术模式多种多样。全球外科医生的首选手术技术和态度与证据之间似乎存在差异。进一步的研究应集中于制定国际指南，以减少实践差异，并为患者提供 LDH 的最佳治疗。
无。
