Appropriateness of Indications for Surgery of Lumbar Disc Hernia and Spinal Stenosis

Evaluates prospectively the appropriateness of surgical intervention indications for herniated lumbar intervertebral disc or spinal stenosis in 328 consecutive patients undergoing the operation in two university neurosurgery departments in Switzerland. The findings were that indications for surgery were considered to be appropriate or equivocal in 62% of the patients and inappropriate in 38%. Among the 38% of the procedures rated inappropriate, about half were so rated because of insufficient activity restriction before the procedure. One year after surgery, 74% of the patients perceived the results of the operation to be good or very good. The major conclusion is that appropriateness as measured by the criteria established by the American panel identified a large percentage of practice as inappropriate; however, the criteria, if modified to include new findings about the lack of efficacy of bed rest, probably would lower the percentage. Thus, this article not only points out the amount of inappropriate care given for people with lumbar disc hernia and spinal stenosis, but indicates that the criteria for judging appropriateness must be updated frequently.