1. 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

2. 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)

3. 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

4. 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%)

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

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

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

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

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

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

11. 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 ) (39%)
The good renown of our hospital and staff (incl. recommendation of operated patients) (61%)

12. 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 !

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

14. 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 !

15. THANK YOU
FOR YOUR
ATTENTION !