Steroid Use in the Management of Spinal Cord Injury.

Web survey results for: Fehlings J, Brodke D, Wang JC. Steroid use in the management of spinal cord injury. SpineLine. 2006; 7(March-April):14-17.

1. Which of the following statements best reflects your opinion of the patient at this time?

70%   believe the patient is asymptomatic and at low risk for neurological deterioration

30%   believe the patient is asymptomatic but at high risk for neurological deterioration

1. Do you use steroids for the treatment of spinal cord injuries?

100%   yes

0           no

2. Which of the following best reflects your plan at this time?

60%   no surgery needed at this time

20%   surgery is optional and up to the patient to decide

20%   surgery is recommended at the current time

2. If you utilize steroids for your acute spinal cord
injury patients, which of the following is most accurate?

100%   I use high dose steroids in accordance with the NACIS II & III recommended protocols

0           I use steroids for spinal cord injuries but not in accordance with the NACIS II & III recommended protocols

3. If this was your neck, would you choose surgical treatment at this time?

20%    yes

80%    no

3. I feel the use of steroids for acute spinal cord
injuries is:

83%    reasonable and appropriate

0          unproven and inappropriate

17%    optional and should be left to the discretion of the treating physician(s)

1. What would be your recommendation for this patient?

77%   referral to an interdisciplinary pain management/ rehabilitation program

14%   lumbar fusion (PLIF +/- pedicle screw instrumentation)

9%    disc replacement

1.  What would you recommend as the preferred treatment for this patient?

36%    nonsurgical with halo

12%    nonsurgical with cervical collar

52%    operative treatment

2.  What do you consider the most important determinant of clinical outcome?

19%   positive provocation discography

5%     reliance on opioids

24%   anxiety and depression

52%   work disability

2. If you chose operative intervention, what
approach would you recommend?

72%   anterior

8%     posterior

3. Based on this Curve/Countercurve presentation, when confronted with a similar patient, would you change your clinical recommendations?

38%    yes

62%    no

Web survey results for: Alanay A, Gelb D, Wang JC. Spinal stenosis with degenerative lumbar scoliosis: fusion versus decompression alone. SpineLine. 2006;5(September/October);16-20.

1. If the patient required surgical intervention, what would be your treatment plan?

41%   microdecompression of the involved levels with lateral recess and foraminal decompression on the right side

13%   laminectomy and decompression of the involved levels without fusion

23% decompression of the involved levels and fusion of only the limited levels that were decompressed

23% decompression of the involved levels and fusion of the entire curve (more extensive fusion of the lumbar spine encompassing the lumbar curve)

1. Which approach are you most comfortable with for this patient?
36%   long-term opioid therapy
27%   specific quota-based exercises plus cognitive behavioral therapy

9%     b followed by a (if necessary)

27%   none of the above; would recommend surgical intervention now

2. Patients with lumbar scoliosis and stenosis
requiring a decompression will typically require a concomitant fusion...

50%   true

50%   false

2. In your practice, are you hesitant to prescribe LTOAT for chronic pain?

55%   yes

45%   no

3. I believe a unilateral microdecompression with a tubular retractor is less destabilizing than a similar decompression using traditional retractors...

59%   true

41%   false