Gopal Vinu V
Department of Neurosurgery, Medical College, " Gowreesapattom," Kottayam, Kerala, India.
J Neurosci Rural Pract. 2021 Jan;12(1):159-164. doi: 10.1055/s-0040-1722103. Epub 2021 Jan 29.
To identify the current management modalities practiced by neurosurgeons in India for degenerative lumbar disc disease. Survey questionnaires were prepared in Google forms. It covered the following aspects of managing the lumbar disc pathology: (1) Demographic, institutional details, experience of surgeons, (2)choice of surgical procedures, (3) use of endoscopy and minimally invasive techniques, and (4) pre- and postoperative care. Responses obtained were entered in SPSS datasheet and analyzed. Of the 300 surveys sent, 80 were returned and response rate was 26.6%. But four surveys were highly incomplete and were discarded from the analysis. So, the study content is from the analysis of practices of 76 spinal surgeons working in different parts of the country. Majority of the spine surgeons ( = 70) were neurosurgeons, while 6 were orthopaedic surgeons. Fifty-four were from urban area, 12 from semiurban area, and 10 from rural area. Forty-seven spine surgeons practiced in a teaching hospital. Total 73.6% of spine surgeons opted initial medical management. Sixty-three percent preferred microlumbar discectomy (MLD) and only eight neurosurgeons preferred minimally invasive techniques. None of the respondents used in situ fusion. Fifty-three percent of spine surgeons preferred early mobilization (first postoperative day). Fifty-nine percent preferred to follow-up patients clinically and opted for magnetic resonance imaging only when recurrence or infection was suspected. The institutional nature (government teaching, government nonteaching, private teaching, and private nonteaching) and location of the hospital (urban/semiurban/rural) were found to be influencing the preferred surgical technique, trial of medical management, or postoperative care and complications. Considerable practice variations exist for medical and perioperative management. The preferred treatment of choice of majority was MLD, although laminectomy and discectomy were still used by many. Consensus lacks in the operative, perioperative, and postoperative management of degenerative disc disease. Present survey points toward the importance of making management guidelines for this common spinal surgical entity.
为确定印度神经外科医生目前针对退行性腰椎间盘疾病所采用的管理模式。
调查问卷通过谷歌表单制作。它涵盖了腰椎间盘病变管理的以下方面：（1）人口统计学、机构详情、外科医生的经验，（2）手术方式的选择，（3）内窥镜检查和微创技术的使用，以及（4）术前和术后护理。将获得的回复录入SPSS数据表并进行分析。
在发出的300份调查问卷中，有80份被退回，回复率为26.6%。但有4份调查问卷极不完整，被排除在分析之外。因此，本研究内容来自对该国不同地区76名脊柱外科医生实践情况的分析。大多数脊柱外科医生（n = 70）是神经外科医生，而6名是骨科医生。54名来自城市地区，12名来自半城市地区，10名来自农村地区。47名脊柱外科医生在教学医院执业。总计73.6%的脊柱外科医生选择初始药物治疗。63%的医生更倾向于显微腰椎间盘切除术（MLD），只有8名神经外科医生倾向于微创技术。没有受访者采用原位融合术。53%的脊柱外科医生倾向于早期活动（术后第一天）。59%的医生更倾向于临床随访患者，仅在怀疑复发或感染时才选择磁共振成像检查。发现医院的机构性质（政府教学、政府非教学、私立教学和私立非教学）以及医院位置（城市/半城市/农村）会影响首选的手术技术、药物治疗试验或术后护理及并发症。在药物治疗和围手术期管理方面存在相当大的实践差异。
大多数人首选的治疗方法是MLD，尽管许多人仍使用椎板切除术和椎间盘切除术。在退行性椎间盘疾病的手术、围手术期和术后管理方面缺乏共识。本次调查表明制定针对这种常见脊柱外科疾病的管理指南很重要。
