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Patients’ beliefs about diagnosis and treatment of cervical spondylosis with radiculopathy

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Abstract

Background

The clinical results of surgical spine care may be influenced by the patients’ understanding and knowledge of his or her condition, treatment options and decision-making process. The aim of this survey study was to evaluate certain beliefs and opinions of patients with a degenerative condition in the cervical spine with a history of cervical radiculopathy such as importance of magnetic resonance imaging, risk factors, treatment alternatives and effectiveness.

Methods

An anonymous questionnaire survey was performed on two different patient populations with a degenerative condition in the cervical spine with a history of cervical radiculopathy referred to the outpatients’ clinics of two neurosurgical departments in Germany and Norway. The survey consisted of seven questions: four questions about the respondents’ gender and age, history of previous spine surgery and/or conservative treatment for cervical disorder and three questions regarding the importance of imaging in the decision-making process, patients’ willingness to undergo cervical surgery based on imaging findings even with few or no symptoms and the effectiveness of surgical or conservative treatment.

Results

Two hundred eleven patients answered the questionnaire. Sixty-seven percent of all patients with a degenerative cervical condition believe that results from MRI studies are more important than clinical findings. Forty-seven percent were willing to undergo surgery based on MRI showing abnormalities even without or having few symptoms. Fifty percent believe that surgery is more effective in the treatment of axial neck pain.

Conclusion

Misbeliefs and misconceptions exist concerning certain aspects of the diagnosis and management in patients with degenerative conditions in the cervical spine with a history of cervical radiculopathy in a large proportion of patients referred to neurosurgical outpatient clinics.

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Funding

No funding was received for this research.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Clemens Weber.

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Conflicts of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

The study was approved by the Ethics Comission of the Medical Faculty at the Technical University of Munich (project no. 40/16S) and the Regional Committee for Medical and Health Research Ethics for Western Norway. For this type of study formal consent is not required.

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Comments

Spine surgeons are well aware of the importance of psychosocial factors and patient expectations for outcome particularly in surgery for degenerative disc disease. Patient beliefs greatly influence patient expectations and thus directly impact the outcome of our patients.

The authors have adapted the work by Franz et al. [5] to the cervical spine and to two European centers. They are to be congratulated on analyzing this important issue and alerting us to the questionable patient opinions on imaging findings and surgical care. In our visually dominated and technology-oriented world, these results may not be surprising, but need to be addressed in our outpatient clinics and ideally in community-based patient education programs. Otherwise, radiological findings will continue to drive patients to demand surgical treatment and be unsatisfied if their imaging findings are not “corrected.” This is particularly problematic in an environment in which surgeons are blamed for performing too much spine surgery.

There obviously are some limitations of the study. The authors chose two patient populations from different health care systems based on the assumption that Norwegian patients are referred to the academic center directly by the GP, while German patients go through outside specialist care first. With 26% of Munich patients (in contrast to only 8% in Stavanger) presenting to the outpatient clinic without any previous conservative care despite a rate of previous spine surgery of 63% (vs. 16%), the opposite seems to be true. This parallels the experience in other countries showing that particularly surgically treated patients tend to present directly to the surgical department or surgeon they know rather than going via the pathways suggested by the system. Further work is warranted to address the misconceptions and logistics of patient care.

Claudius Thome

Tirol, Austria

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Weber, C., Behbahani, M., Baardsen, R. et al. Patients’ beliefs about diagnosis and treatment of cervical spondylosis with radiculopathy. Acta Neurochir 159, 2379–2384 (2017). https://doi.org/10.1007/s00701-017-3356-0

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  • DOI: https://doi.org/10.1007/s00701-017-3356-0

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