Alexander Vaccaro, MD, and Charles Fisher, MD, penned an article about evidence-based medicine to measure spinal interventions in Spine, as posted in Medscape.
The article examines six areas where recent extensive research shows the clinical norm for treatment may not generate the best outcomes for all patients, or the most cost-effective treatment. Advanced data gathering and analytics show which patients achieve the best outcomes, but it's difficult to change the paradigm of care among experienced physicians.
Here are six areas where recent studies are shifting the spine care mindset:
1. Rigid brace for symptomatic osteoporotic compression fracture — Surgeons often employ a rigid pract for patients to feel more comfortable and function better in the short term after symptomatic osteoporotic compression fracture, but Kim et al shows soft or rigid orthosis might not benefit from bracing. Not using the brace could realize cost savings and avoid complications from the bracing application.
2. Interspinous devices for lumbar stenosis — Surgeons may use an interspinous device for stability and assistance in neural decompression in spinal stenosis patients. The implantable device could improve pain relief and function more than just decompression. However, Richter et al shows the device may not have additional patient-reported outcomes after two years.
3. Managing lumbar spondylosis — The SPORT trial shows in early and midterm follow-up, patients with degenerative spondylolisthesis and spinal stenosis might see more improved pain and function over conservative treatment. But surgeons are now becoming more granular with their treatment approach; studies like Rampersaud et al show particular subgroups of patients may have similar results with minimally invasive decompression as they do with decompression and fusion.
4. Degenerative disc disease diagnosis and management — Cohen et al shows patients with cervical radicular arm pain has mixed results when comparing conservative and interventional treatments; a combination intervention could be most effective.
5. Spinal deformity — Data on spinal deformity outcomes comparing operative and non-operative approaches could change care pathways in the future. For example, Protopsaltis et al introduced a new measurement — the T1 pelvic angle as a radiographical parameter — could allow surgeons to more easily perform preoperative and intraoperative measurements to restore age-appropriate spinal alignment.
6. Rod insertion for spinal deformity patients — Smith et al examines rod failure after spinal deformity correction and shows pedicle screw subtraction osteotomy significantly increases rod fracture risk.
"This finding has truly changed surgeon behavior as the norm now is the addition of satellite rods and alternative fusion techniques after pedicle subtraction osteotomy which may significantly improve implant durability at long-term follow-up," wrote the article authors.