"Unnecessary" spinal surgery: A prospective 1-year study of one surgeon's experience.
"Unnecessary" spinal surgery: A prospective 1-year study of one surgeon's experience.
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"不必要的 "脊柱手术： 一位外科医生为期一年的前瞻性经验研究。
DOI：
10.4103/2152-7806.82249
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发表时间：
2011-01-01
影响因子：
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通讯作者：
Hood, Donald C
中科院分区：
文献类型：
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作者：
Epstein, Nancy E;Hood, Donald C
背景技术背景：随着时间的推移，美国境内以及不同地理区域的脊柱手术频率存在明显差异。这些差异的一个可能的来源是手术的标准。方法：在一年的时间[2009年11月至2010年10月]，资深作者，神经外科医生，看到274例颈椎和腰椎，办公室咨询。如果患者被告知他们需要由另一名外科医生进行脊柱手术，但仅表现出疼痛，没有神经功能缺损，也没有明显的异常放射学发现[动态X线，MR扫描和/或CT扫描]，则将其分配到“不必要手术”组。在274名咨询中，45名患者被告知他们需要由外部外科医生进行手术，尽管他们的神经和放射学检查结果并不异常。另外2名患者被告知需要进行腰部手术，而事实上，调查结果表明有必要进行颈部手术。这47例患者包括91例颈椎投诉患者中的21例[23.1%]和183例腰椎投诉患者中的26例[14.2%]。计划的21例颈椎手术包括1-4节段前路椎间盘切除术/融合术[18例患者]、椎板切除术/融合术[2例患者]和后路颈椎椎间盘切除术[1例患者]。计划的26例腰椎手术涉及单节段/多节段后路腰椎椎间融合：单节段[13例患者]、双节段[7例患者]、3节段[3例患者]、4节段[2例患者]和5节段[1例患者]。29名患者患有一种或多种重叠的合并症。结论：在一年的时间里，由一名神经外科医生就诊的274次脊柱会诊中，有47次[17.2%]被安排进行“不必要的手术”。
BACKGROUND: There are marked disparities in the frequency of spinal surgery performed within the United States over time, as well as across different geographic areas. One possible source of these disparities is the criteria for surgery.METHODS: During a one-year period [November 2009-October 2010], the senior author, a neurosurgeon, saw 274 patients for cervical and lumbar spinal, office consultations. A patient was assigned to the "unnecessary surgery" group if they were told they needed spinal surgery by another surgeon, but exhibited pain alone without neurological deficits and without significant abnormal radiographic findings [dynamic X-rays, MR scans, and/or CT scans].RESULTS: Of the 274 consults, 45 patients were told they needed surgery by outside surgeons, although their neurological and radiographic findings were not abnormal. An additional 2 patients were told they needed lumbar operations, when in fact the findings indicated a cervical operation was necessary. These 47 patients included 21 [23.1%] of 91 patients with cervical complaints, and 26 [14.2%] of 183 patients with lumbar complaints. The 21 planned cervical operations included 1-4 level anterior diskectomy/fusion [18 patients], laminectomies/fusions [2 patients], and a posterior cervical diskectomy [1 patient]. The 26 planned lumbar operations involved single/multilevel posterior lumbar interbody fusions: 1-level [13 patients], 2-levels [7 patients], 3-levels [3 patients], 4-levels [2 patients], and 5-levels [1 patient]. In 29 patients there were one or more overlapping comorbidities.CONCLUSIONS: During a one-year period, 47 [17.2%] of 274 spinal consultations seen by a single neurosurgeon were scheduled for "unnecessary surgery".