PATIENT’S ROAD TO DISK HERNIATION SURGERY P. Tanchev, D. Dikov, A. Djerov, D. Lashkov, P. Yolov Gorna Bania University Hospital of Orthopaedics Sofia, Bulgaria

PURPOSE Patient’s point of view on health care is very important in clinical medicine This retrospective inquiry study evaluates the preoperative story of patient’s consent to accept surgical treatment for massive disk herniation (MDH)

MATERIALS AND METHODS 30 patients with MDH operated in our insitution were included (selection by independent researcher, eligible patients – consecutively recruited, 2007) Inclusion criteria: - severe LBP and/or leg pain - clinically and EMG – confirmed neurologic deficit - imaging diagnostics – large (massive, extruded) DH - minimally 6 weeks of failed conservative treatment Exclusion criteria: advanced degenerative changes other spinal disorders previous surgeries

MATERIALS AND METHODS A questionnaire including a request for a range of answers revealing the patients’ road to the decision to accept surgery was circulated (“a look at the other side of the barricade”) 2 patients did not send back the questionnaire (93% coverage) AGE - 40 y. (19-59) GENDER - ♀ 17 (60%) ♂ 11 (40%)

RESULTS DURATION OF COMPLAINTS average 42 mo. (1-264) < 6 weeks - 1 (3.5%) > 6 weeks - 27 (96.5%)

RESULTS HOW MANY TIMES DID YOU VISIT THE DOCTOR PRE-OP ?

RESULTS HOW MANY DOCTORS DID YOU VISIT PRE-OP ? 1 - 3 - 19 p. (68%)

RESULTS WHAT KIND OF SPECIALISTS TREATED YOU PRE-OP? GP - 1 p. (3.5%) GP + Neurologist - 24 p. (86%) !!! GP + Neurosurgeon - 1 p. (3.5%) GP + Orthopaedic surgeon – 1 p. (3.5%) GP + Other specialists (incl. neurologist !) - 19 p. (68%)

RESULTS WHAT KIND OF PRE-OP DIAGNOSTICS? X-ray - 28 p. (100%) X-ray + MRI - 16 p. (57%) X-ray + CT - 16 p. (57%) Complete set of imaging diagnostics and EMG – 11 (39%) EMG as out-patient diagnostics – 11(39%)

RESULTS WHAT KIND OF PRE-OP CONSERVATIVE TREATMENT? No treatment - 1 p. (3.5%) Drugs only - 11 p. (39%) Physiotherapy only - 2 p. (7%) Systematic conservative therapy (incl. drugs, physiotherapy,etc.) – 14 p. (50%)

RESULTS WHY DID YOU GIVE YOUR CONSENT FOR SURGERY ? - Advice at our out-patient ward was entirely convincing (no previous information about facility’s or staff’s renown ) - 11 (39%) The good renown of our hospital and staff (incl. recommendation of operated patients) - 17 (61%)

CONCLUSIONS CHAOS ON “THE OTHER SIDE OF THE BARRICADE” CAUSED BY INSUFFICIENT AND CONTRO- VERSIAL INFORMATION ABOUT SURGERY, TECHNIQUES, OUTCOMES, EFFICIENCY,etc. AND LACK OF CONSENSUS AMONG DIFFERENT SPECIALISTS REGARDING DIAGNOSTICS AND TREATMENT OF MDH !

CONCLUSIONS PATIENT’S ROAD TO SURGERY – “LONG AND WINDING” PATIENT’S FEAR FOR SURGERY STILL TO OVERCOME

CONCLUSIONS INSUFFICIENT OR INADEQUATE ADVICING BY GPs AND NEUROLOGISTS BETTER COLLABORATION BETWEEN GPs AND SPINAL SURGEONS IS NECESSARY RAISING AWARENESS AND BETTER INFORMATION OF PATIENTS ABOUT THE POSSIBILITIES OF SURGERY IS NECESSARY CONSENSUS DOCUMENT ACCEPTED BY THE DIFFERENT SPECIALTIES IS STRONGLY MISSING !

THANK YOU FOR YOUR ATTENTION !