title: Intraregional differences of perioperative management strategy for lumbar disc herniation: is the Devil really in the details?
abstract: BACKGROUND
  This study intends to evaluate whether regional common habits or differences in case-volume between surgeons are significative variables in the perioperative management of patients undergoing surgery for lumbar disc herniation.
  
  
  METHODS
  An e-mail survey was sent to all neurosurgeons working in Lombardy, Italy's most populated region. The survey consisted of 17 questions about the perioperative management of lumbar disc herniation.
  
  
  RESULTS
  Forty-seven percent (47%) out of 206 Lombard neurosurgeons answered the survey. Although in some respects there is clear evidence in current literature on which is the best practice to adopt for an optimal management strategy, we noticed substantial differences between respondents, not only between hospitals but also between surgeons from the same hospital. Still, no differences were evident in a high vs low case-volume comparison.
  
  
  CONCLUSIONS
  We identified no regional clusterization as for practical principles in the perioperative management of lumbar disc herniation and neither was case-volume a significative variable. Other causes may be relevant in the variability between the perioperative management and the outcomes achieved by different specialists.
authors.affiliation: Neurosurgery Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Zoia
authors.affiliation: Neurosurgery Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy; Neurosurgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Pavia, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Bongetta
authors.affiliation: Neurosurgery Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
authors.forename: Jacopo C
authors.initials: JC
authors.lastname: Poli
authors.affiliation: Neurosurgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Pavia, Italy.
authors.forename: Mariarosaria
authors.initials: M
authors.lastname: Verlotta
authors.affiliation: Neurosurgery Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
authors.forename: Raffaelino
authors.initials: R
authors.lastname: Pugliese
authors.affiliation: Neurosurgery Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gaetani
keywords: discectomy; lumbar disc herniation; sciatica; surgery