Revised: December 19, 2013
Accepted: January 13, 2014
Published online: April 18, 2014
Evidence-based medicine (EBM) is a common concept among medical practitioners, yet unique challenges arise when EBM is applied to spinal surgery. Due to the relative rarity of certain spinal disorders, and a lack of management equipoise, randomized controlled trials may be difficult to execute. Despite this, responsibility rests with spinal surgeons to design high quality studies in order to justify certain treatment modalities. The authors therefore review the tenets of implementing evidence-based research, through the lens of spinal disorders. The process of EBM begins with asking the correct question. An appropriate study is then designed based on the research question. Understanding study designs allows the spinal surgeon to assess the level of evidence provided. Validated outcome measurements allow clinicians to communicate the success of treatment strategies, and will increase the quality of a given study design. Importantly, one must recognize that the randomized controlled trial is not always the optimal study design for a given research question. Rather, prospective observational cohort studies may be more appropriate in certain circumstances, and would provide superior generalizability. Despite the challenges involved with EBM, it is the future of medicine. These issues surrounding EBM are important for spinal surgeons, as well as health policy makers and editorial boards, to have familiarity.
Core tip: This paper highlights the intricacies of spinal research. The difficulties of conducting high quality research in spinal surgery are discussed, but the tools for success are outlined. Specifically, the tenets of implementing evidence-based research are provided, along with a discussion of validated outcome measures which will increase the quality of a given study design. Importantly, the randomized controlled trial should not always be considered the best study design for a given research question, and observational cohort studies may be more appropriate in certain circumstances. Ultimately, spinal surgeons are responsible for evidence-based research to justify treatment paradigms.