gms | German Medical Science

Objective: There are several strategies for the treatment of monosegmental cervical disc herniation by an anterior approach, but the scientific basis is not clear. The aim of this investigation was to evaluate the degree of consensus among neurosurgeons in this type of treatment on a national basis in Germany. Data of a recent survey in 2008 are compared with previous results of the year 2001.

Methods: In December 2001 a questionnaire consisting of 11 questions regarding preoperative work up, surgical technique, choice of implants and postoperative care was mailed to German neurosurgical departments (n=165). A slightly modified questionnaire with 13 questions on the same topic was again sent out in January 2008 in order to assess changes in the therapeutical strategy occurring over time. Answers were evaluated and analysed by descriptive statistics (% of neurosurgeons) comparing the year 2001 and with 2008.

Results: 2001 a total of 114 (69%) questionnaires were returned, of which 112 (68%) could be evaluated. An almost equal return rate could be achieved in 2008: 139 questionnaires (69.5%) were returned, 136 (68%) could be evaluated. Concerning the preoperative work-up in 2008 less neurosurgeons perform plain radiographs (81.3% vs. 61.0%), CT Scans (18.8% vs. 9.6%) and electrophysiological examinations (EMG 8.9% vs. 4.4%, SSEP 7.1% vs. 2.9%) compared to 2001. MRI has become the most important imaging modality with an increase from 61% in 2001 to 75% in 2008. With regard to surgical treatment 68.8% of surgeons choose a right sided approach in 2001, in 2008 78.7%. The number of discectomies without implant placement has remained unchanged (2.7% vs. 2.2%), whereas the use of tricortical iliac crest bone grafts (8.0% to 0.7%) and PMMA (19.6% to 8.1%) has decreased significantly. Cages have become the preferred implant material (34.8% vs. 47.8%). New in 2008 is the implantation of cervical disc prosthesis although the overall number is still low (2.9%). A soft or rigid orthosis was prescribed postoperatively by 50% in 2001. This number decreased to one third in 2008.

Conclusions: Our data show that MRI has become the imaging modality of choice for the preoperative work up. More important, PMMA and especially the use of iliac crest bone grafts are no longer used, but have been replaced by cages as standard implants. Nevertheless our data still show a great variability in this type of surgery among German neurosurgeons reflecting a persistent lack of consensus.