Post-operative care following lumbar microdiscectomy: A survey of Australasian neurosurgeons.

Abstract

Introduction: Lumbar microdiscectomy is the most commonly performed spine surgery procedure. Over time lumbar discectomy has evolved to a minimally invasive procedure performed in an outpatient setting in many international institutions. Patients traditionally have been advised to restrict activity following lumbar spine surgery.1 However, post-operative instructions are heterogeneous. The purpose of this report is to assess, by survey, the post-operative care practices and recommendations of Australasian neurosurgeons in the era of the modern lumbar microdiscectomy. Material(s) and Method(s): A survey of Australasian Neurosurgeons was conducted by email invitation sent to all full members of the Australasian Neurosurgical Society. The survey consisted of 11 multi-choice questions answered by an anonymized online survey distributed electronically by the Australasian Neurosurgical Society. The survey consisted of questions relating to operative indications, technique, and post-operative instructions for lumbar microdiscectomy. Result(s): The survey was sent to all Australasian Neurosurgeons. 71 responses were received of which 68 were complete (28.9%). The geographic distribution of respondents was well spread. Only complete responses are included. Operative Indications: most surgeons reported they would consider a period of either 4-8 weeks (42.7%)(29) or 8-12 weeks (32.4%)(22) as the minimum duration of radicular pain adequate to offer surgery. Operative Technique: unilateral muscle dissection with unilateral discectomy was practiced by 76.5%(52) of surgeons. A tubular retractor system was used by 20.6%(14). Operative microscope was the most commonly employed method of magnification (76.5%)(52), no magnification was used by only (2.94%)(2). Post-operative Care. The majority of surgeons (55.9%)(38) always refer patients to undergo inpatient physiotherapy. No sitting restrictions were advised by 22.1%(15) of surgeons with 39.7% (27) advising patients to sit as comfort allows post-operatively. When advised sitting restrictions were most commonly recommended for a period of up to four weeks (57.4%)(39). Lifting restrictions were advised by 83.8% of surgeons. Such restrictions were most commonly advised for periods up to 4-8 weeks (52.17%). Conclusion(s): This study reports the results of a survey of Australasian neurosurgeons regarding lumbar discectomy practices. The vast majority of neurosurgeons perform unilateral muscle dissection and discectomy under magnification. A majority of Australian neurosurgeons advised sitting restrictions. Lifting restrictions are advised by approximately 80% of Australasian neurosurgeons. The persistent recommendation of activity restrictions following lumbar discectomy is consistent with a recent survey of British spine surgeons.2 The results of these two surveys suggest a possible role for further investigation of the role of postoperative activity restrictions following lumbar discectomy in the era of minimally invasive spine surgery.