Evidence-Based Spine Surgery Recommendations Issued

Recommendations based on review of six spine surgery studies

FRIDAY, Nov. 18 (HealthDay News) -- Evidence-based recommendations from six studies can help guide clinical practice in spinal surgeries, according to a review published online Nov. 14 in Spine.

Charles G. Fisher, M.D., M.H.Sc., from the University of British Columbia in Vancouver, Canada, and colleagues reviewed six studies and provided evidence-based recommendations which affect the clinical practice for spinal surgeries. The six studies discussed the impact of worker's compensation status in posterolateral lumbar fusion; decompression for degenerative scoliosis; bone union rates between autologous and local bone graft in posterior lumbar interbody fusion (PLIF); anterior column support in adjacent segment degeneration (ASD) after spinal fusion; minimally invasive and open transforaminal interbody fusion in spondylolisthesis; and dynamic stabilization adjacent to single-level fusion.

The authors offered a weak recommendation toward consideration of worker's compensation status in surgical decision-making and patient counseling. Radiographic and clinical outcome measures were inconclusive for decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy. There was low quality evidence, without clinical correlation, for local autograft bone compared to autologous iliac crest graft in PLIF. There were no differences for ASD after anterior lumbar interbody fusion with or without posterior lumbar fusion. The safety and efficacy of minimally invasive spinal surgeries need further research before application in clinical practice. It is strongly recommended that posterior dynamic stabilization should not be used above a fusion to prevent adjacent segment degeneration.

"Surgery for low back pain remains a controversial issue. A number of factors influence surgical outcomes and valid isolation of specific prognostically-important factors is challenging," the authors write.

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