2007 Curve/Countercurve Survey Results

 Bracing vs Surgery for a T12 Burst Fracture

Web survey results for:

Lee JY, Lim MR, Wang JC. Bracing versus surgery for a T12 burst fracture. SpineLine. 2007;1(January/February):14-19.

Web survey results for:

Donelson RG, Sahrmann S, Prather H. Therapeutic exercise: which method is best for lumbar radiculopathy. SpineLine. 2007;2(March/April):15-21.

1. On initial presentation of the patient with this injury in the emergency room, would you recommend surgical or nonsurgical treatment?

56% would recommend surgical treatment

45% would recommend nonsurgical treatment

1. Do you routinely specify the type of therapeutic exercise you want your patient with lumbar radiculopathy to receive?
  100%    yes
   0            no

2. I believe this patient will progress into kyphosis with more vertebral body collapse if treated nonsurgically:

59% true

41% false

2. What would you recommend for treatment of this patient?

100%   would recommend therapeutic exercise utilizing the Mechanical Diagnosis and Treatment method.

0   would recommend therapeutic exercise utilizing the Mechanical Movement Impairment Method of Treatment.

0   would recommend therapeutic exercise at the therapist's discretion.

0   wouldn't recommend therapeutic exercise.

3. If the patient were to remain neurologically intact but had progression of kyphosis, I would recommend surgery in the situation where:

23% would recommend surgery if the kyphosis progressed 10 degrees

54% would recommend surgery if the kyphosis progressed over 10° but less than 20°.

23% would tolerate significant kyphosis as long as the patient remained neurologically intact.

4. I believe it is important to obtain an MRI of this spinal injury

91% true

9% false

1. Although there is pathology in both the cervical and lumbar spine, I would recommend the treatment priority be placed on the:
75%   would recommend priority treatment of the cervical spine.  
25%    would recommend priority treatment of the lumbar spine.  

1. After considering this case, you would:
a. recommend education and medication.
b. comprehensive conservative care including medication, bracing, therapeutic exercise and education.
c. medication, bracing and vertebral augmentation.
d. none of the above.

...results to come

2. If only the cervical spine pathology was present without lumbar pathology, I would recommend the following for the cervical spine:
92%  would recommend surgical treatment for the cervical spine at this time.
8%    would not recommend surgery for the cervical spine at this time.

2. When faced with managing a symptomatic subacute vertebral compression fracture (less than eight weeks of symptoms) related to osteoporosis in an elderly patient, which factors influence you to recommend vertebral augmentation initially?
a. the patient’s functional limitations and co-morbidities that are increased with immobilization.
b. the extent (t-score on bone DEXA scan) of the osteoporosis.
c. location and severity (amount of compression) of the fracture.
d. the patient’s score on the visual analog scale.

...results to come

3. If only the lumbar spine pathology was present without the cervical pathology, I would recommend the following for the lumbar spine:
75%    would recommend surgical treatment for the lumbar spine at this time.
25%    would not recommend surgery for the lumbar spine at this time.

3. In your practice, do you often find that patients with symptomatic subacute vertebral compression fractures related to osteoporosis can be managed with comprehensive conservative care?
a. most of the time.
b. some of the time.
c. rarely.
d. I refer these patients to other practitioners.

...results to come

4. If the lumbar spine was asymptomatic in this current case where pathology is present in both the cervical and lumbar spine, I would recommend the following:
92%    would recommend surgery for the cervical spine before the lumbar spine.
8%     would recommend surgery for the lumbar spine before the cervical spine.

1. I feel that the current limited residency work hours are safer and very good for patient care.
69.4%  True
30.6% False

2. I feel that the institution of the limited residency work hours affects the educational experience of the residents:
47.1% This affects the educational process in a negative manner.
20.6% This affects the educational process in a positive manner.
32.4% I feel this does not affect the educational process of the residents.

3. I think the limitation of resident work hours is overall good.
70.6% True
29.4% False