title: Management of Symptomatic Cervical Disk Herniation: A Survey Among Dutch Neurosurgeons.
abstract: METHODS
  A questionnaire survey.
  
  
  OBJECTIVE
  To assess the preferred surgical technique, the optimal timing of surgery, and the expectations of different surgical techniques of neurosurgeons in the Netherlands, regarding patients with cervical disc herniation (CDH).
  
  
  BACKGROUND
  To treat CDH, multiple surgical techniques are performed. Due to the lack of consensus, the daily routine management may vary.
  
  
  METHODS
  All 134 neurosurgeons of the Dutch Association of Neurosurgery were sent a survey, evaluating the operative management as well as the attitude towards different surgical treatments for CDH.
  
  
  RESULTS
  Ninety-six (74.4%) of the neurosurgeons treating CDH completed the survey. Anterior cervical discectomy with fusion (ACDF) was the standard procedure for the majority of neurosurgeons (76.3%). ACDF was expected to have the highest effectiveness on arm pain, yet also a higher risk for complications as compared with anterior cervical discectomy (ACD). Approximately, 47.9% of the surgeons regarded a minimal duration of 8 to 12 weeks of radicular arm pain before deciding to perform surgery. Regarding the risk of recurrent CDH, DCF was expected to give the highest risk, whereas ACDF the lowest.
  
  
  CONCLUSIONS
  Despite the lack of solid evidence in favor for ACDF this survey showed that ACDF is the preferred technique to treat cervical radiculopathy. A minimum duration of 8 to 12 weeks of radicular arm pain was considered the optimal timing to perform surgery for CDH by the majority of the neurosurgeons. Whether to fuse or not remains a controversial subject in degenerative spinal surgery. This study emphasizes the need of high-quality evidence on the optimal surgical management of CDH.
  
  
  METHODS
  N/A.
authors.affiliation: Department of Neurosurgery, Erasmus MC: University Medical Center Rotterdam, The Netherlands.|Department of Pain Medicine, Erasmus MC: University Medical Center Rotterdam, The Netherlands.|Department of Physical Therapy, Erasmus MC: University Medical Center Rotterdam, The Netherlands.
authors.forename: Judith D
authors.initials: JD
authors.lastname: de Rooij
authors.affiliation: Department of Neurosurgery, Erasmus MC: University Medical Center Rotterdam, The Netherlands.
authors.forename: Pravesh S
authors.initials: PS
authors.lastname: Gadjradj
authors.affiliation: Department of Pain Medicine, Erasmus MC: University Medical Center Rotterdam, The Netherlands.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Huygen
authors.affiliation: Department of General Practice, Erasmus MC: University Medical Center Rotterdam, The Netherlands.
authors.forename: Pim A J
authors.initials: PAJ
authors.lastname: Luijsterburg
authors.affiliation: Department of Neurosurgery, Erasmus MC: University Medical Center Rotterdam, The Netherlands.
authors.forename: Biswadjiet S
authors.initials: BS
authors.lastname: Harhangi
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000601:surgery*; D004185:Disability Evaluation; D017586:Diskectomy / Q000379:methods; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008297:Male; D019635:Neurosurgical Procedures; D011843:Radiculopathy / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D011795:Surveys and Questionnaires