目的:目前还没有标准化的方法来评估和管理脊柱手术患者的围手术期神经功能缺损(PND)。这项调查旨在评估临床实践指南(CPG)的认识和使用情况,并调查进行脊柱手术的外科医生如何看待和管理PND,以及他们如何看待开发CPG对PND管理的价值。
方法:向AOSpine国际社区发出了参与邀请。问题与意识有关,使用CPG,和人口统计。分析整个样本和亚组的结果。
结果:在770名受访者中,659(85.6%)报告知道指南的存在,其中,578(87.7%)使用指南承认。总的来说,58.8%的外科医生报告说,在经过器械融合的多级颈椎后路减压后,对四肢瘫痪的患者进行治疗感到不舒服。虽然22.9%会考虑立即返回手术室,其他77.1%的人赞成先进行某种调查/医疗干预,如进行磁共振成像(85.9%),服用大剂量皮质类固醇(50.2%),或增加平均动脉压(44.7%)。总的来说,90.6%的外科医生认为用于PND管理的CPG是有用的,并且94.4%的外科医生有可能或极有可能在其临床实践中使用这些CPG。
结论:大多数受访者都知道并经常在实践中使用CPG。大多数进行脊柱手术的外科医生报告说,管理PND感觉不舒服。然而,他们高度重视这一创造,并可能在其管理中使用CPG。
OBJECTIVE: There is no standardized approach to assess and manage perioperative neurologic deficit (PND) in patients undergoing spinal surgery. This survey aimed to evaluate the awareness and usage of clinical practice
guidelines (CPGs) as well as investigate how surgeons performing spine surgeries feel about and manage PND and how they perceive the value of developing CPGs for the management of PND.
METHODS: An invitation to participate was sent to the AOSpine International community. Questions were related to the awareness, usage of CPGs, and demographics. Results from the entire sample and subgroups were analyzed.
RESULTS: Of 770 respondents, 659 (85.6%) reported being aware of the existence of
guideline(s), and among those, 578 (87.7%) acknowledged using
guideline(s). Overall, 58.8% of surgeons reported not feeling comfortable managing a patient who wakes up quadriplegic after an uneventful multilevel posterior cervical decompression with instrumented fusion. Although 22.9% would consider an immediate return to the operating room, the other 77.1% favored conducting some kind of investigation/medical intervention first, such as performing magnetic resonance imaging (85.9%), administrating high-dose corticosteroids (50.2%), or increasing the mean arterial pressure (44.7%). Overall, 90.6% of surgeons believed that CPGs for the management of PND would be useful and 94.4% would be either likely or extremely likely to use these CPGs in their clinical practice.
CONCLUSIONS: Most respondents are aware and routinely use CPGs in their practice. Most surgeons performing spine surgeries reported not feeling comfortable managing PND. However, they highly value the creation and are likely to use CPGs in its management.