Translating Procedural Spine Science into Cross-Cultural Clinical Practice: Methodological Questions and Answers

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In their reviews of the study of cervical radiofrequency neurotomy (RFN) by MacVicar, Borowczyk et al. [1], some of the referees raised questions that were not critical of the internal validity of the study but which pertained to its external validity. In essence, these questions concerned the context of the study and differences between New Zealand and the United States with respect to patients and medical practices. Conventionally, such questions would be answered in a covering letter to the satisfaction of the Editor. However, in the present case, the questions and answers contained information that would be of wider interest beyond the peer-review process. That information serves not only to elaborate and explain the study of MacVicar, Borowczyk et al. [1], but also to underscore the wider relevance of stringent standards of practice. For that reason, we have composed this letter to serve as a compendium to the published article. It provides answers to several of the key questions raised in the review process. At the time that the study was commenced, New Zealand was in a unique position. RFN was not practiced, was not available to patients, and was not reimbursed. In one sense, New Zealand was behind the rest of the world, but in another sense it had not been polluted with disparate methods of RFN of unknown efficacy. When a small group of practitioners wanted to make RFN available, the opportunity arose to do it well, and avoid mistakes made elsewhere in the world. The senior medical advisor of the single insurance company that covers accident compensation in New Zealand faced a dilemma. There was no universally accepted technique for cervical RFN, and no consistent protocol. Various Dutch, German, and other protocols had been found wanting [2], and their outcomes were not impressive. Consequently, …