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Controversies in Cervical Discectomy and Fusion: Practice Patterns Among Canadian Surgeons

Published online by Cambridge University Press:  02 December 2014

Gwynedd E. Pickett ,
Jessica Van Soelen  and
Neil Duggal
Gwynedd E. Pickett
Affiliation:
Division of Neurosurgery, London Health Sciences Centre, London, Ontario, Canada
Jessica Van Soelen
Affiliation:
Division of Neurosurgery, London Health Sciences Centre, London, Ontario, Canada
Neil Duggal
Affiliation:
Division of Neurosurgery, London Health Sciences Centre, London, Ontario, Canada
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Abstract

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Objective:

Optimal fusion technique and peri-operative management of patients undergoing anterior cervical discectomy (ACD) is unclear.We document current practice patterns among Canadian spinal surgeons regarding the surgical management of single level degenerative cervical spondylosis.

Methods:

We conducted a web-based survey of neurosurgeons and spinal orthopedic surgeons in Canada. We asked questions pertaining to the management of single level cervical degenerative disc disease causing radiculopathy and/or myelopathy, including frequency of fusion following single-level discectomy, preferred fusion technique, indications and frequency of use of anterior plating, and use of an external cervical orthosis following surgery. Demographic factors assessed included training background, type and length of practice.

Results:

Sixty respondents indicated that their practice involved at least 5% spine surgery and were included in further analysis. Neurosurgeons comprised 59% of respondents, and orthopedic surgeons 41%. Fusion was employed 93% of the time following ACD; autologous bone was the preferred fusion material, used in 76% of cases. Neurosurgeons employed anterior cervical plates in 42% of anterior cervical discectomy and fusion cases, whereas orthopedic surgeons used them 70% of the time. External cervical orthoses were recommended for 92% of patients without plates and 61% of patients with plates. Surgeons who had been in practice for less than five years were most likely to be performing spinal surgery, using anterior cervical plates, and recommending the postoperative use of cervical orthoses.

Conclusion:

Practice patterns vary among Canadian surgeons, although nearly all employ fusion and many use instrumentation for single-level ACD. Training background, and type and length of practice influence practice habits.

Type
Other
Information
Canadian Journal of Neurological Sciences , Volume 31 , Issue 4 , November 2004 , pp. 478 - 483
Copyright
Copyright © The Canadian Journal of Neurological 2004

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