Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters

Abstract

BACKGROUND CONTEXT Lumbar discectomy is one of the most common procedures in spine surgery. Variability exists in pre-, intra- and postoperative management strategies. We undertook a survey of Canadian neurosurgeons at two points in time one decade apart (2007 and 2017) to assess these practice patterns. PURPOSE To ascertain and compare practice patterns over time in the surgical management of one-level lumbar discectomies in the Canadian adult population. The results will be compared with the known evidence-based literature. STUDY DESIGN/SETTING Observational, descriptive study – 17 question national survey. OUTCOME MEASURES Questionnaire asking 17 questions regarding the pre-, intra- and postoperative management of one-level lumbar discectomy, that is preoperative antibiotic use, preferred choice of magnification, use of MIS, use of fibrin glue for dural tear, preferred time of discharge and return to work, etc. METHODS One-page questionnaire faxed and/or emailed to Canadian Neurosurgeons with questions relating to their practice of this common spine procedure. Data was analyzed using Chi-square statistics. RESULTS A total of 112 completed surveys were returned in 2007 – 64% response rate and 104 in 2017 – 42% response rate. Statistically significant differences between the two points in time were noted with: more spine fellowship trained 25 (33%) 2017 versus 15 (15%) 2007 (p=.006), use of pre-op MRI 64 (84%) 2017 versus 27 (28%) 2007 (p=.001), use of intramuscular injection 56 (75%) 2017 versus 43 (44%) 2007 (p=.001), more used both microscope and loups 19 (25%) 2017 versus 3 (3%) 2007 (p=.001), more use of tubular retraction 25 (33%) 2017 versus 12 (16%) 2007 (p=.001), greater use of fibrin glue for a dural tear 70 (92%) 2017 versus 75 (77%) 2007 (p=.007), increased rate of same-day discharge 45 (59%) 2017 versus 18 (18%) 2007 (p=.001), a quicker return to work in 2017 in less than 6 weeks (p=.002). No statistical differences were noted with pre-incision localization, preoperative antibiotics, preincision local anesthetic use, use of fat graft or epidural steroids. In either survey, the majority would not operate on a primary complaint of back pain with lumbar discectomy. CONCLUSIONS Our survey has shown significant changes in practice aspects in the management of one-level lumbar disc herniation. These changes include usage of MRI over CT preoperatively, more frequent use of microscope, increasing use of tubular retraction and the tendency toward earlier discharge from hospital and return to work. These results could form the basis for the design of randomized control trials in the evaluation of the best management approach for this common spine procedure.