Larequi-Lauber T, Vader JP, Burnand B, Fankhauser H, De Tribolet N, Paccaud F; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1994; Abstract No. 321.
Institut universaire de medecine sociale et preventive, Lausanne, Switzerland.
INTRODUCTION: Surgical cures for herniated lumbar intervertebral disc and for spinal stenosis are high volume procedures which exhibit wide regional variations. It has been postulated that the main reason for treatment failure is poor selection of candidates for the procedure. METHODS: Using explicit screening criteria developed in 1987 by an expert panel in the United States, we prospectively evaluated appropriateness of indications for surgical cure of herniated lumbar intervertebral disc and/or spinal stenosis in a consecutive sample of patients in the Neurosurgical unit of a university hospital between April and October, 1992. This study involved no intervention; assessment of "appropriateness8 did not influence the decision to operate. RESULTS: Indications for 232 consecutive operations were assessed, there were 141 men and 91 women. Median age was 45, mean age 47 (46 for men, 48 for women; range 17-79). Of the 336 possible individual indications, study cases involved only 38 (11%). Applying degree of appropriateness as an ordinal scale, 59 (25%) indications were appropriate, 77 (34%) equivocal, and 96 (41%) inappropriate. 58% (55/95) of "inappropriate8 cases (22 indications) were "inappropriate8 due to insufficient restriction of activity prior to the procedure. Absence of key neurological deficits was associated with 31% (n = 29) of "inappropriate8 cases. DISCUSSION: Our results indicate a major difference between the criteria proposed by the 1987 panel and current practice in the surgical unit involved in this study. Since 1987, the nature of management of sciatica has evolved towards earlier mobilization and less restriction of activity, the major reason for inappropriate indications in our study. This suggests the need for updating ratings of appropriateness.
Publication Types:
Keywords:
- Evaluation Studies
- Female
- Hernia
- Humans
- Intervertebral Disk Displacement
- Lumbar Vertebrae
- Male
- Sacrum
- Sciatica
- Spinal Stenosis
- United States
- methods
- hsrmtgs
Other ID:
UI: 102211753
From Meeting Abstracts