Evidence-Based Spine Surgery

Abstract

Literature review. To describe the state of the literature regarding the performance of lumbar fusion for low back pain due to degenerative disease of the spine. The effectiveness and costs associated with spinal surgery have been a topic of significant debate in both the popular press and professional literature. Evidence-based medicine techniques have been applied to many areas of spinal surgery. The results of these analyses are being used by practicing physicians, payors, and others to determine what procedures are appropriate for certain patient populations. This manuscript describes the methodology, strengths, and weaknesses of evidence-based medicine approaches to spinal surgery. The case for lumbar fusion as a treatment for chronic low back pain due to degenerative disc disease is described as an example. Evidence-based medicine is a useful tool for summarizing and grading the evidence available in the literature for or against a particular treatment strategy. Its utility is limited by the quality of the primary literature, and the absence of proof cannot be equated with the proof of absence.