An assessment of the variation in the practice of lumbar discectomy and its role in axial back pain
Authors
Sandeep Mishra ; Kanwaljeet Garg ; Bipin Chaurasia ; Bhargavi R Budihal ; Harsh Deora ; Vivek Tandon ; Manoj Phalak ; Shashwat Mishra ; Amandeep Kumar ; G E Umana ; Jesus Lafuente ; Andreas K Demetriades ; Yoon Ha ; Manmohan Singh ; P S Chandra ; S S Kale ; Mehmet Zileli
Citation
Journal of Craniovertebral Junction & Spine, Vol.14(3) : 259-267, 2023-07
Back pain ; discectomy ; herniation ; lumbar ; survey
Abstract
Background: Lumbar discectomy is performed for symptomatic lumbar disc herniation and is one of the most widely performed spinal surgical procedures worldwide in a variety of ways. This survey aimed at providing an overview/perspective of different practice patterns and the impact of lumbar discectomy on axial back pain with or without sciatica.
Methods: An online survey was performed using the application "Google Forms." The link to the questionnaire was distributed to neurosurgeons through personal E-mail and social media platforms.
Results: We received 333 responses. The largest percentage of responses across five continents was from Asia (66.97%, n = 223). The mean age of the respondents was 40.08 ± 10.5 years. A total of 66 respondents (20%) had a spine practice of 7%-90%, and 28 respondents had a spine practice of 90%-100% (8.4%). The number of respondents who practiced microscopic discectomy using a tubular retractor (n = 143 respondents, 42.9%) was nearly equal to the number of respondents who practiced open discectomy (n = 142 respondents, 42.6%). An almost equal proportion of respondents believed discectomy does not help in relieving axial back pain. Only 20.4% (n = 68) of respondents recommend bed rest for a longer duration postoperatively.
Conclusions: Our survey revealed that only 22.2% of spine surgeons recommended discectomy in patients with radiological disc herniation with axial back pain alone and preferred a minimally invasive method of discectomy. Almost half of them believed discectomy to be ineffective for axial low back pain and only a few recommended prolonged bed rest postoperatively.