The assessment of appropriate indications for laminectomy.

Détails

ID Serval
serval:BIB_11648
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
The assessment of appropriate indications for laminectomy.
Périodique
Journal of Bone and Joint Surgery. British Volume
Auteur(s)
Porchet F., Vader J.P., Larequi-Lauber T., Costanza M.C., Burnand B., Dubois R.W.
ISSN
0301-620X
Statut éditorial
Publié
Date de publication
1999
Peer-reviewed
Oui
Volume
81
Numéro
2
Pages
234-239
Langue
anglais
Résumé
We have developed criteria to determine the appropriate indications for lumbar laminectomy, using the standard procedure developed at the RAND corporation and the University of California at Los Angeles (RAND-UCLA). A panel of five surgeons and four physicians individually assessed 1000 hypothetical cases of sciatica, back pain only, symptoms of spinal stenosis, spondylolisthesis, miscellaneous indications or the need for repeat laminectomy. For the first round each member of the panel used a scale ranging from 1 (extremely inappropriate) to 9 (extremely appropriate). After discussion and condensation of the results into three categories laminectomy was considered appropriate in 11% of the 1000 theoretical scenarios, equivocal in 26% and inappropriate in 63%. There was some variation between the six categories of malalignment, but full agreement in 64% of the hypothetical cases. We applied these criteria retrospectively to the records of 196 patients who had had surgical treatment for herniated discs in one Swiss University hospital. We found that 48% of the operations were for appropriate indications, 29% for equivocal reasons and that 23% were inappropriate. The RAND-UCLA method is a feasible, useful and coherent approach to the study of the indications for laminectomy and related procedures, providing a number of important insights. Our conclusions now require validation by carefully designed prospective clinical trials, such as those which are used for new medical techniques.
Mots-clé
Back Pain, Intervertebral Disk Displacement, Laminectomy, Lumbar Vertebrae, Practice Guidelines as Topic, Retrospective Studies, Sciatica, Spinal Stenosis, Spondylolisthesis
Pubmed
Web of science
Création de la notice
19/11/2007 13:02
Dernière modification de la notice
20/08/2019 13:39
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