The assessment of appropriate indications for laminectomy

We have developed criteria to determine the appropriate indications for lum bar laminectomy, using the standard procedure developed at the RAND corpora tion and the University of California at Los Angeles (RAND-UCLA), A panel o f five surgeons and four physicians individually assessed 1000 hypothetical cases of sciatica, hack pain only, symptoms of spinal stenosis, spondyloli sthesis, miscellaneous indications or the need for repeat laminectomy, For the first round each member of the panel used a scale ranging from 1 (extre mely inappropriate) to 9 (extremely appropriate), After discussion and cond ensation of the results into three categories laminectomy was considered ap propriate in 11% of the 1000 theoretical scenarios, equivocal in 26% and in appropriate in 63%, There was some variation between the six categories of malalignment, but full agreement in 64% of the-hypothetical cases. We applied these criteria retrospectively to the records of 196 patients wh o had had surgical treatment for herniated discs in one Swiss University ho spital. We found that 48% of the operations were for appropriate indication s, 29% for equivocal reasons and that 23% mere inappropriate. The RAND-UCLA method is a feasible, useful and coherent approach to the stu dy of the indications for laminectomy and related procedures, providing a n umber of important insights. Our conclusions now require validation by care fully designed prospective clinical trials, such as those which are used fo r new medical techniques.