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Incidence of unusual and clinically significant histopathological findings in routine discectomy
1Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Object:
Routine histopathological examination of discectomy specimens remains common practice in many hospitals, although it rarely detects unsuspected clinically significant disease. Controversy exists as to the effectiveness of this practice. The objectives of this study were to compare the authors' experience with a review of the literature.
Methods:
In a retrospective database analysis the authors identified all intervertebral disc specimens obtained during spinal procedures over an 8-year period (1996-2004). Cases of benign (nonneoplastic and noninfectious) indications for surgery were included in the study, whereas cases of nonbenign indications were excluded. The final pathological diagnoses were reviewed, and a chart review was performed to determine whether any unexpected findings affected subsequent patient care. A total of 1858 discectomy specimens were identified: 1775 of these were obtained in 1719 routine discectomy procedures. Unexpected histopathological findings were identified in four cases, and none was clinically significant.
Conclusions:
Routine histopathological examination of disc specimens is not justified. The decision to send specimens for pathological examination should be determined on a case-by-case basis after consideration of the clinical presentation, results of laboratory and imaging studies, and intraoperative findings.
Insights
Routine histopathological examination of discectomy specimens is not cost-effective. This study found no clinically significant unexpected findings in over 1700 routine disc surgeries, suggesting a case-by-case approach is better.
Area of Science:
- Spine Surgery
- Pathology
- Medical Economics
Background:
- Routine histopathological examination of discectomy specimens is a common practice.
- The clinical significance and cost-effectiveness of this practice are debated.
- Previous studies suggest it rarely detects unexpected clinically significant disease.
Purpose of the Study:
- To evaluate the utility of routine histopathological examination of discectomy specimens.
- To compare the authors' experience with existing literature on the topic.
- To determine if unexpected findings in routine disc specimens impact patient care.
Main Methods:
- Retrospective analysis of 1858 intervertebral disc specimens from 1996-2004.
- Inclusion of specimens from benign surgical indications only.
- Review of pathological diagnoses and patient charts for unexpected findings and their clinical significance.
Main Results:
- 1775 specimens were from routine discectomy procedures.
- Unexpected histopathological findings were identified in only 4 cases.
- None of the unexpected findings were clinically significant or affected patient care.
Conclusions:
- Routine histopathological examination of disc specimens is not justified.
- The decision to submit specimens should be individualized based on clinical presentation, imaging, and intraoperative findings.
- This practice may not be a cost-effective use of resources.
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