SPINAL CT - OPINION OF 150 PATIENTS HOSPI TALIZED FOR DISCAL SCIATICA

OBJECTIVES: There would be some discordance between patient expectatio ns and expert recommendations concerning computed tomography (CT) of t he spine for discal disorders. We analyzed patient opinion. PATIENTS A ND METHODS: At admission, a 25-item questionnaire was given to 150 pat ients hospitalized in a rheumatology unit for discal sciatica. Patient s were asked to express their expectations concerning the CT explorati on. RESULTS: Seventy percent of the patients had already undergone CT explorations requested by a general practitioner (55%) or a specialist (45%), 20% had had two CT explorations and 20% magnetic resonance ima ging. Seventy-five percent felt they should have had a CT scan earlier , 85% thought a CT should be performed for back pain of less than one month duration and 96% in case of sciatica for 2 months or more. Patie nts felt their exploration came ''late'' because the physician was und er financial pressure (52%), had incorrectly appreciated the patient's need (28%) or was incompetent in the matter (22%). Nevertheless, 15% of the patients recognized that the CT scan could be useless and 89% k new that all cases or hernia are not operable. Thirty percent recogniz ed that hernias can go undetected on the CT scan and 78% that tey may remain asymptomatic. Finally, 56% of the patients thought that the CT scan would not change their treatment and only 23% expected to undergo surgery sooner because of the CT exploration. DISCUSSION: Several fac tors would explain what patients expect from CT exploration of the spi ne: patient understanding that causes other than discal hernia can cau se back pain (98%) or sciatic (77%); their fear of having another diso rder (56% wanted to be reassured, which would explain in part why 27% hoped the CT would improve pain, 50% wanted to ''see'' their discal he rnia, and 30 wanted to eliminate another cause of their pain); patient distrust of clinical diagnosis which they felt was less patient than CT (80% of the patients for generalists and 70% for specialists). Pati ent expectations did not appear to be limited by fear of irradiation ( unrecognized by 90% of the patients) nor the cost of the exploration w hich was over-estimated by 70% of them. (C) 1998, Masson, Paris.