Lumbar sacralization and L4-L5 microdiscectomy, a prospective cohort study on radiologic and clinical outcomes.

Aim: To evaluate the role of lumbar sacralization (LS) on the surgical outcomes of L4-L5 microdiscectomy. Methods: This prospective cohort study was conducted in a university referral hospital. The patients with L4-L5 disc herniation and eligible for microdiscectomy were enrolled and allocated in G1 (with LS) and G2 (no LS). After the L4-L5 microdiscectomy patients were followed, clinical and radiological parameters were collected to investigate the influence on the outcomes. Recurrence, low back outcome score (LBOS), and the Oswestry disability index (ODI) were defined as main outcomes. Results: Two hundred and forty patients (n = 120, each), were reviewed in the final analysis. There was no difference between groups regarding baseline characteristics. Postoperative radicular and back pain was more severe in LS(P < 0.05). Univariate analysis showed recurrence was significantly higher in LS with a direct correlation with postoperative back pain persistence and low LBOS (p = 0.001). Age had a negative impact on G2 recurrence(p = 0.008). LS had a negative impact on LBOS and ODI scores. Postoperative radicular pain and higher lumbar lordosis were associated with a higher disability (ODI) index. Conclusion: L4-L5 microdiscectomy in patients with lumbar sacralization was associated with higher recurrence rates, worse ODI and LBOS scores, persistent postoperative axial back pain, and radicular pain. Postoperative axial back pain and poor LBOS results could effectively predict a higher recurrence rate following L4-L5 microdiscectomy in lumbar sacralization.

Comparison the Postoperation Results of Discectomy with Nucleoplasty in Single Cervical Disc Herniation.

BACKGROUND: The standard treatment for cervical disc herniation is open discectomy surgery but some of techniques, such as nucleoplasty were applied by neurosurgeons in recent decade. The aim of this study was to compare the postoperation results of open discectomy and nucleoplasty methods in people suffering from single cervical disc herniation. MATERIALS AND METHODS: In a clinical trial study that performed during 2012-2013, 70 patients who candidate for neck surgery were selected and randomly divided into two groups. The first group was operated with standard discectomia and the second group was operated with nucleoplasty method. All patients were followed neck pain, upper limb pain and common complications included discitis, infection and hematoma in 2 weak, 1, 2, 3, and 6 months after operation. All data were analyzed using SPSS software. RESULTS: Cervical pain mean from before the operation to 6 months after operation had no significant difference between two groups, but radicular pain had significant difference in 2 and 3 months after operation (P < 0.05). It is notable that after operation it is not observed any discitis, infection and hematoma of operated place. CONCLUSION: Doing nucleoplasty surgery in patients suffering from single cervical disc herniation causes decrease in cervical and radicular pain, at least as the same as discectomy method. Since now it is possible in our country to apply this method and on the other hand, in this method, time of surgery, postoperation complications, hospital costs, and period of convalescence is low, it is preferred in patients suffering from cervical disc and its application is advised.

Preventive Effects of Pre- and Intra-operative Marcaine, Lidocaine, and Marcaine Plus Lidocaine on Pain Relief in Lumbar Disc Herination Open Surgery.

BACKGROUND: As marcaine is administered to a great extent due to minor complications and reasonable expenses and as discectomy is prevalently used in Iran, this study makes a comparison between effect of marcaine alone, lidocaine alone, and marcaine plus lidocaine on pain relief of patients undergoing lumbar disc open surgery. MATERIALS AND METHODS: In a clinical trial study, 192 patients were selected and randomly divided into four groups. Patients in Groups 1-4 received 0.5 ml marcaine during surgery, 5 ml lidocaine 2% before incision, 5 ml lidocaine 2% before incision plus 5 ml marcaine during surgey and normal saline, respectively. After patients gained knowledge of visual analog scale (VAS) criteria, their severity of pain was measured and was recorded in their profiles, along with demographic details and history of diseases. After surgery and their transfer to their rooms, their severity of pain was measured and recorded again by using VAS criteria. Finally, difference between the four groups was compared by SPSS software. RESULTS: The mean (±standard deviation) of postoperative pain in marcaine + lidocaine, marcaine, lidocaine, and normal saline was 3.5 ± 1.3, 3.5 ± 1.6, 36.1.9, and 4.2 ± 1.8, respectively, and we did not observe any significant difference in severity of pain after surgery in these groups (P = 0.15). The highest and lowest degree of satisfaction occurred in marcaine-lidocaine group and control group, respectively, (40 patients [83.3%] vs. 25 patients [52.1%]). CONCLUSION: Lidocaine-marcaine treatment reduces the need to opiates in cases of postoperative pain relief of discectomy and provides patients with great satisfaction.

Comparison of the Effects of 3 Methods of Intrathecal Bupivacaine, Bupivacaine-Fentanyl, and Bupivacaine-Fentanyl-Magnesium Sulfate on Sensory Motor Blocks and Postoperative Pain in Patients Undergoing Lumbar Disk Herniation Surgery.

BACKGROUND: The aim of this study was to investigate the effects of adding intrathecal (IT) fentanyl and magnesium sulfate (MgSO4) to bupivacaine on sensory motor blocks and postoperative pain in patients undergoing lumbar disk herniation surgery. METHODS: In a double-blind randomized clinical trial, the patients undergoing lumbar disk herniation surgery were allocated to receive hyperbaric bupivacaine (A), or hyperbaric bupivacaine and fentanyl (B), hyperbaric bupivacaine, fentanyl and MgSO4 (C) IT. Data were collected regarding the onset of sensory block and time to regression to T10, time to complete motor block and full motor recovery, time to first analgesic requirement, postoperative pain score, and analgesic consumption and side effects. P<0.05 was considered to be statistically significant. RESULTS: A total of 105 patients were randomized and assigned to 3 groups (n=35 in each groups). There were no significant differences between groups in regard to time to reach the T10 level of sensory block (P=0.82), time to regression to T10 (P=0.11), and the time to complete motor block (P=0.58). Meanwhile, the time to complete recovery of motor function was significantly longer in group C (116.4±18.4, 126.4±25.5, 130.2±15.7 min, respectively, P=0.016). Time to first analgesic requirement was also significantly longer in group C (3.26±1.12, 5.57±0.92, 6.91±1.27 h, respectively, P<0.001). Total morphine consumption was significantly less in group C (14.3±4.3, 8.3±3.5, 6±3.6 mg, respectively, P<0.001). The severity of pain was significantly less in C group (P<0.001). CONCLUSION: In patients undergoing lumbar disk herniation surgery, IT MgSO4 in combination with bupivacaine-fentanyl can decrease severity of postoperative pain and analgesic consumption without additional side effect.

The effect of age on result of straight leg raising test in patients suffering lumbar disc herniation and sciatica.

BACKGROUND: Ninety percent of all people sometimes during their lives experience low back pain, and 30-40% develops radicular leg pain with the sciatica characteristics. Although for clinical diagnosis of lumbar disc herniation (LDH) straight leg raising (SLR) test in 85-90% of cases indicates LDH, but in our practice with LDH patients this test is frequently negative despite radicular leg pain due to LDH. Hence, we decided to evaluate this test in LDH in different age groups. MATERIALS AND METHODS: All patients with leg pain referring to neurosurgery clinic were enrolled. Those with a history of pain other than sciatica excluded and SLR test and magnetic resonance imaging (MRI) of the lumbosacral spine performed. The patients with negative MRI findings excluded and finally 269 patients with true sciatica and positive MRI were included. SLR tests were performed for different age groups. RESULTS: Of 269 patients, 167 were male. The age range was 16-80 years. The most involved levels were L5-S1 (47%) and L4-L5 (42%), respectively. The rate of positive SLR result, which was 100%, 87% and 82% for 10-19, 20-29 and 30-39 years age group respectively. With an increment of age, the rate of positive test regularly declined. The chance of positive SLR in men is 1.3 times the women (odds ratio [OR] 2.4; 95% confidence interval [CI] = 1.265-4.557; P = 0.007). Increasing the age has suppression effect in positivity of SLR so that for each 1-year the chance of SLR become 0.27 times less to become positive and this is also statically meaningful (OR = 0.271;95% CI = 0.188-0.391; P,0.001). The chance of positive SLR for patients under 60 is 5.4 folds more than patients above 60 years old (OR = 5.4; 95% CI = 4-8.3; P, 0.001). CONCLUSION: Age, sex (male), and disk level had statistically the effect on SLR positive test.

'Cuff Sign' a new maneuver for decision-making in patients with carpal tunnel syndrome.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy that results from compression of the median nerve within the carpal tunnel. In most patients, the diagnosis can be proposed based on patient history and clinical symptoms, with physical findings being attributed only in more severely affected patients. The purpose of this study is to introduce a reliable and accurate method for the proper selection of patients with mild carpal tunnel syndrome (CTS), for surgery. MATERIALS AND METHODS: Electerodiagnostic studies are performed before and after placement of the cuff of the sphygmomanometer at the arm (Cuff sign), at a mean arterial pressure, for three minutes. Thirty symptomatic patients with mild findings on electrodiagnostic studies and 49 asymptomatic control hands have been included. RESULTS: Fifteen patients reported good pain relief on the first postoperative day (50%), which increased to 21 on the fouteenth postoperative day (70%). The sensory latency changes were significantly higher in the pain relief group, both on the first and fourteenth postoperative days. CONCLUSION: Considering the fact that cooperation of the patients is not necessary and the double effects of direct pressure and ischemia over the proximal parts of the median nerve leads to prolonged latencies, this test is a useful method for decision-making in patients with severe symptoms of CTS, despite the mild electrodiagnostic findings.

Comparison of open surgical discectomy versus plasma-laser nucleoplasty in patients with single lumbar disc herniation.

BACKGROUND: Intervertebral disc herniation is a major cause of low back pain. Several treatment methods are available for lumbar disc herniation including Chemonucleolysis, open surgery, nucleoplasty, laser disc decompression, and intradiscal electrothermal therapy. The high prevalence of lumbar disc herniation necessitates a minimally invasive yet effective treatment method. In this study, we compared the outcomes of open surgery and nucleoplasty method in patients with single lumbar disc herniation. MATERIALS AND METHODS: This study was a noninferiority randomized clinical trial conducted in one of the University Hospitals of Isfahan Medical University; The Alzahra Hospital. About 200 patients with the diagnosis of lumbar disc herniation were recruited and were assigned to either the treatment or control groups using block randomization. One group received open surgery and the other group received nucleoplasty as the method of treatment. Patients were revisited at 14 days, 1, 2, 3 months, and 1-year after surgery and were assessed for the following variables: Lower back pain, lower limb pain, common complications of surgery (e.g., discitis, infection and hematoma) and recurrence of herniation. RESULTS: The mean (standard deviation) severity of low back pain was reduced from 6.92 (2.5) to 3.43 (2.3) in the nucleoplasty group (P = 0.04) and from 7.5 (2.2) to 3.04 (1.61) in the discectomy group (P = 0.73). Between group difference was not statistically significant (P = 0.44), however, time and treatment interaction was significant (P = 0.001). The level of radicular pain evaluated 1 year after treatment was reduced from 8.1 (1.2) to 2.9 (1.2) (P = 0.004) and from 7.89 (2.1) to 3.6 (2.5) (P =0.04) in the discectomy and the nucleoplasty groups respectively, significant interaction between time and treatment options was observed (P < 0.001) while there was no significant difference between two treatment groups (P = 0.82). CONCLUSION: Our results show that while nucleoplasty is as effective as open discectomy in the treatment of lumbar disc herniation, it is also less invasive with higher patient compliance. Taking factor such as decreased cost and duration of the surgery, as well as faster recovery in patients into account; we suggest considering nucleoplasty as an effective method of treatment in patients with single-level disc herniation.

Analyzing the effects of intra-operation video-clip display on hemodynamic and satisfaction of patients during lumbar discectomy under spinal anesthesia.

OBJECTIVE: Most neurosurgeons and anesthesiologists prefer the less invasive intervention for most surgeries; recently, the lumbar anesthesia is more popular method. In this study we have tried to distract the attention of the patients to their favorite video-clip instead of their surrounding operating room background to evaluate the hemodynamic as well as their satisfaction during the operation. METHODS: 80 patients who were scheduled for an elective one level discectomy under the regional spinal anesthesia enrolled in this prospective randomized clinical trial. The patients were randomized with sealed envelope method and each envelope was randomly assigned from this set of envelops to be either in case group one (video group) or control groups two (no audio and video and only head phone on their ears) group. In all patients, systolic and diastolic blood pressure, pulse rate and SPO2 were measured and recorded in the questionnaire charts. RESULTS: Of the 80 patients with Lumbar disk herniation, 53 patients were male and 27 female. The mean age for all patients was 44 year. Systolic and diastolic blood pressure at the end of surgery was significantly lower in video group (P=0.045 and 0.004). Systolic Blood pressure differences between 3(rd) and 5(th) and the end of the surgery with minute zero was significantly less in the video group. (P=0.025, 0.018 and 0.030). Diastolic blood pressure differences between 3(rd) and 5(th) and the end of the surgery with minute zero was significantly less in the video group.(P=0.051, 0.019 and 0.15). Pulse rate differences between first, 3(rd), 5(th) and exactly before leaving the recovery room with minute zero was significantly less in the video group. (P=0.015, 0.028, 0.030 and 0.008). CONCLUSION: According to our study, by displaying patient's favorite video clip during the surgical intervention we could highly reduce the patient's attention to what is happening in operating room and therefore, decrease their anxiety and stress.

Analysing the effect of early acetazolamide administration on patients with a high risk of permanent cerebrospinal fluid leakage.

In this study, we examined the role of early acetazolamide administration in reducing the risk of cerebrospinal fluid (CSF) leakage in patients with a high risk of permanent CSF leakage. In a randomised clinical trial, 57 patients with a high risk of permanent CSF leakage (rhinorrhea, otorrhea, pneumatocele or imaging-based evidence of severe skull-base fracture) were analysed. In the experimental group, acetazolamide, at 25 mg/kg/day, was started in the first 48 hours after admission. In the control group, acetazolamide was administered after the first 48 hours at the same dose administered to the patients in the experimental group. The following factors were compared between the two groups: duration of CSF leakage, duration of hospital stay, incidence of meningitis, need for surgical intervention and need for lumbar puncture (LP) and lumbar drainage (LD). All of the patients in the experimental group stopped having CSF leakage less than 14 days after the first day of admission, but 6 out of 21 patients (22%) in the control group continued having CSF leakage after 14 days of admission, which was a significant difference (P=0.01). This study showed that early acetazolamide administration can prevent CSF leakage in patients with a high risk of permanent CSF leak.

Effect of erythropoietin on Glasgow Coma Scale and Glasgow Outcome Sale in patient with diffuse axonal injury.

BACKGROUND: Erythropoietin (EPO) as a major stimulator of red blood cell (RBC) production play a key role on brain protection and have a caring effect on neurons from hypoxic or traumatic injury. The objective of this trial was to study the safety and efficacy of recombinant human EPO (rhEPO) on level of consciousness and other outcomes in patient with post traumatic diffuse axonal injury (PTDAI). METHODS: In a controlled double-blind randomized clinical trial, 54 patients aged 20-47 years were randomly allocated to 2 groups. Subjects in intervention group (n = 27) received 2000U open-label rhEPO (Erythropoietin-ß; Roche, Gren-zach-Wyhlen, Germany) subcutaneously for six doses in two weeks (on days: 2, 4, 6, 8 and 10). The efficacies of the intervention were evaluated by GCS (Glasgow Coma Scale) and GOS (Glasgow Outcome Scale). RESULTS: The patients that were treated by rhEPO improved earlier with the difference between the treatment groups occurring on the day 10 (score differences of 9.6 for GCS and 1.9 for GOS). The better course of the rhEPO-treated patients continued throughout the remaining study period. The hematocrit and red blood cell counts did not increase to levels exceeding the normal range in rhEPO patients. CONCLUSIONS: Intravenous EPO was well tolerated in diffuse axonal injury and was associated with an improvement in patients' outcome in 2 weeks.

An intracranial extramedullary hematopoiesis in a 34-year-old man with beta thalassemia: a case report.

INTRODUCTION: Extramedullary hematopoiesis occurs in approximately 15% of cases of thalassemia. Intracranial deposits of extramedullary hematopoiesis are an extremely rare compensatory process in intermediate and severe thalassemia. CASE PRESENTATION: We present an unusual case of an intracranial extramedullary hematopoiesis with a choroid plexus origin in a 34-year-old Caucasian man with beta thalassemia intermedia, who presented with the complaints of chronic headache and rapid progressive visual loss. CONCLUSION: An intracranial extramedullary hematopoiesis, although extremely rare, should be considered as a potential ancillary diagnosis in any thalassemic patient and therefore appropriate studies should be performed to investigate the probable intracranial ectopic marrow before any surgical intervention.

The effect of impregnated autogenous epidural adipose tissue with bupivacaine, methylprednisolone acetate or normal saline on postoperative radicular and low back pain in lumbar disc surgery under spinal anesthesia; A randomized clinical trial study.

BACKGROUND: Low Back Pain (LBP) and radicular leg pain (RLP) after lumbar disc surgery are great challenges that prevent patients and neurosurgeons in making a surgical decision. By spinal anesthesia, LBP and RLP diminish up to 2 to 3 hours postoperatively. The aim of this study was to determine the effect of impregnated epidural adipose tissue (EAT) with bupivacaine or methylprednisolone acetate on reduction of late postoperative pain after spinal anesthesia. METHODS: This study was performed on lumbar disc herniation surgery under spinal anesthesia. Sixty six patients entered our study who were divided into three groups, EAT impregnated with bupivacaine (group 1), methylprednisolone acetate (group2) and normal saline (control group). The LBP and RLP were evaluated during the first 24 hours postoperatively and 14 days later by visual analogue scale (VAS). RESULTS: Of 66 patients, 53% were female and 47% male. The average (SE) LBP in the first 6 hours after surgery based on VAS were 1.59 ± 0.90 in group one, 2.36 ± 2.38 in group 2 and 3.09 ± 1.41 in control group but the VAS for RLP in this period were 1.95 ± 1.13, 1.31 ± 1.39 and 2.40 ± 1.09, respectively. The average LBP and RLP did not show any differences after 14 days postoperatively. CONCLUSIONS: According to our data bupivacaine was effective on LBP relief and steroid was effective on RLP relief during the first 12 hours after surgery.

A new system for neuronavigation and stereotactic biopsy pantograph stereotactic localization and guidance system.

Everyday, neurosurgeons face the problem of orientation within the brain but the advent of stereotactic surgery and neuronavigation have solved this problem. Frame-based stereotactic systems (FBSS) and neuronavigation systems have their own strengths and priority and pitfalls, which were the main driving force for us to design a new system. This hybrid system comprises three main parts: main frame, monitoring system, and pantograph, which are connected to each other and to the operating table by particular attachments. For using this system, after performing CT SCAN or Magnetic Resonance Imaging (MRI) the axial view will be transferred to Liquid Cristal Display (LCD). In the operating room, the head of the patient fixes to the operating table and registration is completed by two arms of pantograph. We made a simulation operation with our system on an occipital cavernous angioma and a frontal oligodendroglioma. The software, which have been used for simulation were as follows; Poser (version-7), Catia (version 5- R18), and 3 Dimension Max (version 2008). The accuracy of this system is approximately two millimeter. The advantages of this system are: easy to use, much less expensive, and compatible with different devices, which may be needed during neurosurgical operation. For countries that do not have the opportunity to have sophisticated technology and neuronavigation system, we believe that our system is a one-stop solution.

Spironolactone in preventing hypokalemia following traumatic brain injury.

OBJECTIVE: Hypokalemia is a frequent complication observed after traumatic brain injury (TBI). We evaluated the effect of spironolactone on preventing hypokalemia following moderate to severe TBI. METHODS: Patients with moderate to severe TBI, whose Glasgow Coma Scale (GCS) scores of 9-12 and less than 9, respectively, were equally randomized into intervention and control groups, matching with severity of trauma and baseline serum level of potassium. For the intervention group, we administrated spironolactone (1 mg/kg per day) on the second day of admission or the first day of gavage tolerance and continued it for seven days. No additional intervention was done for controls. Hypokalemia (mild: 3-3.5 mg/L, moderate: 2.5-3 mg/L, and severe: less than 2.5 mg/L serum K+) and other electrolyte abnormalities were compared between the two groups at the end of the intervention. RESULTS: Sixty-eight patients (58 males and 10 females) were included with mean age equal to (33.1+/-11.8) years, and GCS equal to 7.6+/-2.8. The two groups were similar in baseline characteristics. Patients who received spironolactone were significantly less likely to experience mild, moderate, or severe hypokalemia (8.8%, 2.9%, and 0) compared with controls (29.4%, 11.7%, and 2.9%, respectively, P less than 0.05). No significant difference was observed between the two groups in the occurrence of other electrolyte abnormalities, hyperglycemia or oliguria. CONCLUSION: Spironolactone within the first week of head injury could prevent the occurrence of late hypokalemia with no severe side effects.

Effects of intraoperative-intrathecal sufentanil injection on postoperative pain management after single level lumbar discectomy.

BACKGROUND: For lumbar disc operation a chain of painful procedures including skin incision, muscle dissection and sometimes laminectomy should be performed. The combination of these manoeuvres results in significant post-operative pain. The standard way to reduce post-operative pain consist of intra-operative injection of local anaesthetic (Bupivicaine or Lidocaine) to the superficial tissues and intravenous, oral or rectal prescription of Opioid analgesics or other analgesics after operation, but inadequate analgesia, constipation and delayed mobilisation are frequent side effect of those treatments. The goal of this study was to reduce postoperative pain of patients which causes a reduction in analgesic consumption and eventually shortened hospital stay and acceleration in physical therapy programs and ambulation. MATERIALS AND METHODS: After ethical comitte approval, patients allocated in two groups A and B. Each group consisted 30 patients which all of them underwent general anesthesia. All of operations performed by same surgeon... After discectomy and at the end of surgery based on patients odd or even number of hospital admission, one group (group-A) received sufentanil (Iranian pharmaceutic company) 0.05/kg intrathecaly injected in surgical level and the placebo group (group-B) normal saline was injected. In recovery room when patients were sufficiently awake for pain assessment, patients were asked to score pain on the verbal pain assessment score In both groups we compaired pain scores pre and postoperativly. The total dose of opioid requirement for patients and its time after operation was recorded. RESULTS: Of the 60 patients (ASA classes I and II) entering the study, no one excluded during our study. 30 patients received intrathecal injection of sufentanil as group-A or case and 30 patients normal saline as group-B or control. Mean age between two groups showed no significant difference. 45.7 year (SD = 11.5) for group-A and 44.3 year (SD = 9.9) for group-B which did not differ between two groups (P = 0.617). Urinary retension happened in 3 patients of group-A and 3 patients of group-B (P = 1). Pruritis happened in 1 patient of group-A and no patient in group-B (P = 0.15). Patients in group-A had reduced analgesic requirments (P = 0.01). Preoperative low back pain based on NPS (numerical pain scores) criteria in group-A shows score 1, (n = 7) score 2, (n = 10) score 3, (n = 11) and score 4 (n = 2) (mean = 2.2667 and SD = 0.9072). These scores in group-B showed score 2 (n = 4) score 3 (n = 16) and score 4 (n = 10) (mean = 3.2 and SD = 0.6644) (P < 0.001). After surgery low back pain assessment in two groups shows in group-A three patients had score 1, score 2, (n = 7) score 3, (n = 11) score 4, (n = 8) score 5 (n = 1) (mean = 2.9 and SD = 1.0289) and in group-B score 4 (n = 17) score 5 (n = 13) (mean = 4.4333 and SD = 0.5040) (P < 0.001). Preoperative lower extremity radicular pain assessment in two groups shows a mean pain score of 8.3 with SD = 0.9523 in group-A and a mean of 8.3448 with SD = 1.1109 in group-B and after operation a mean pain score of 1.7333 with SD = 0.8277 in group-A and a mean of 4.1667 with SD = 0.7466 in group-B. In walking ability assessments pre and postoperatively based on Mann-Whitney test it is shown that in group-A walking ability is better than group-B (P < 0.001). CONCLUSION: In this study we studied the efficacy of intraoperative-intrathecal sufentanil injection versus placebo on post operative pain management. Our study showed that intrathecal (IT) sufentanil provided more effective analgesia postoperatively after single level discectomy. Urinary retention was equal in two groups. For more exact conclusions it is better to do a similar study on more patients.

Single level cervical disc herniation: A questionnaire based study on current surgical practices.

BACKGROUND: Operative procedures like simple discectomy, with or without fusion and with or without instrumentation, for single level cervical disc herniation causing neck pain or neurological compromise have been described and are largely successful. However, there is a debate on definitive criteria to perform fusion (with or without instrumentation) for single level cervical disc herniation. Hence, we conducted a questionnaire based study to elicit the opinions of practicing neurosurgeons. MATERIALS AND METHODS: About 148 neurosurgeons with atleast 12 years of operative experience on single level cervical disc herniation, utilizing the anterior approach, were enrolled in our study. All participating neurosurgeons were asked to complete a practice based questionnaire. The responses of 120 neurosurgeons were analysed. RESULTS: The mean age of enrolled surgeons was 51 yrs (range 45-73) with mean surgical experience of 16.9 yrs (range 12-40 yrs) on single level cervical disc herniation. Out of 120 surgeons 10(8%) had 15-25 years experience and always preferred fusion with or without instrumentation and six (five per cent with 17-27 yrs experience had never used fusion techniques. However, 104 (87%) surgeons with 12-40 yrs experience had their own criteria based on their experiences for performing fusion with graft and instrumentation (FGI), while. 85 (75%) preferred auto graft with cage. CONCLUSIONS: Most of surgeons performed FGI before the age of 40, but for others, patient criteria such as job (heavier job), physical examination (especially myelopathy) and imaging findings (mild degenerative changes on X-ray and signal change in the spinal cord on MRI) were considered significant for performing FGI.