1.  If this were your patient, would you recommend . . .

33%  would recommend intrathecal opioids

42%  would recommend spinal cord stimulation

8%     would recommend no further treatment

17%   would recommend other treatment, ie: epidural steroid injections, physical therapy

1.  After reading arguments for both sides, the treatment of choice for this patient at this time would consist of:

53%  recommend total disc replacement

37%  recommend surgical fusion

5%     recommend no surgery

5%     recommend other motion-sparing device other than disc replacement

2.  If surgical fusion was indicated, the preferred method of fusion would be:

7%    prefer posterolateral fusion alone

21%  prefer anterior fusion

36%  prefer anterior and posterior fusion

36%  prefer posterior fusion with interbody device

1. Which surgical approach would you recommend?
44%   would recommend the endoscopic foraminal approach
56%   would recommend the transcanal approach
0       would recommend another option

1. If you decide to perform an epidural steroid injection:

7%   would use interlaminar approach at the C5-6 level

37%  would use interlaminar approach at the C6-7 or C7-T1 levels

0        would use interlaminar approach at the C7-T1 level with a catheter

56%   would use transforaminal approach at the right C5-6 level

2. Much of the choice depends on the training of individual surgeons . . .

27%  report they are only trained to perform the transcanal approach

0        report they are only trained to perform the
transforaminal approach

73%    report they are trained and able to perform both approaches

2. Have you ever experienced a vascular central nervous system complication from performing a cervical epidural steroid injection?

39%    yes (please go to question 3)

61%    no

3. True or false: the transforaminal approach can achieve the same discectomy/ decompression as the transcanal approach for a standard posterolateral herniated disc. . .

53%   true

47%   false

3. If yes, please identify:

8%    while using interlaminar approach

58%  while using transforaminal approach

17%  report a cervical cord event

17%  report a brain event

 Autologous Bone Graft or BMP-2 for Spinal Fusion?

Web survey results for: Polly DW, Yoo JU, Wang JC. Autologous bone graft or BMP-2 for spinal fusion? SpineLine. 2004;5(September-October):18-22.

1. The bone graft material of choice for this patient:

32%  would use iliac crest autogenous bone graft

0        would use local bone graft only

32%  would use local bone graft augmented with a graft extender

8%     would use bone marrow aspirate with some osteoconductive carrier

28%   would use rhBMP-2

1. As used in your practice, Waddell signs are most indicative of:

17%  repsonded “physiological impairment”

55%  responded “psychological distress”

8%    responded “personality disorder”

20%  responded “malingering”

2. The bone graft material that you would like to use if there were no cost issues, FDA approval concerns or hospital/insurance issues would be:

8%   would choose iliac crest autogenous bone graft

0       would choose local bone graft only

20% would choose local bone graft augmented with graft extender

8%   would choose bone marrow aspirate with some osteoconductive carrier

64%  would choose rhBMP-2

2.  If you were asked to consult on this patient, you would recommend:

59%  would recommend an interdisciplinary, comprehensive pain management program

23%  would recommend a four- to six-week work hardening program with a plan to return this patient to his original job

8%    would recommend referral to a psychiatrist

10%  would recommend no further treatment, immediate claim closure

3. I believe that in the future we will no longer be using iliac crest autogenous bone graft for spinal fusion procedures:

84%  True

16%  False

3. In your opinion, treatment for psychological issues (as presented in this case), should be paid for by the industrial insurance carrier:

63% yes

37% no