[The effect of publications on clinical practice; chemonucleolysis]

The influence on practice of a publication about a randomised clinical trial of chemonucleolysis (CNL) vs. herniotomy in patients with lumbar prolapsed intervertebral disc was investigated, using a questionnaire sent to neurosurgeons and neurologists. There were no differences between responses of neurosurgeons and neurologists, nor between academic and non-academic specialists. 63 (57%) of the respondents stated they were not influenced by the paper, 48 (43%) stated they were. 40 of those said they thought more favourably about herniotomy, 8 more favourably about CNL. Opinion about CNL and advice to patients about CNL had no effect on being influenced or not by the article. However, they did modify the direction of influence: both negative and positive opinions about CNL appeared to be reinforced by the publication. Opinion about the best treatment and advice to patients were not fully consistent with each other.