Topic Highlight
Copyright ©2014 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Orthop. Apr 18, 2014; 5(2): 89-93
Published online Apr 18, 2014. doi: 10.5312/wjo.v5.i2.89
Research in spinal surgery: Evaluation and practice of evidence-based medicine
Mark E Oppenlander, Christopher M Maulucci, George M Ghobrial, James S Harrop
Mark E Oppenlander, Christopher M Maulucci, George M Ghobrial, James S Harrop, Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, United States
Mark E Oppenlander, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph Hospital and Medical Center, Phoenix, AZ 85003, United States
Author contributions: Oppenlander ME designed the research, contributed to data review, drafted the paper; Maulucci CM and Ghobrial GM contributed to data review and drafting of paper; Harrop JS was the consultant supervisor, contributed to review and approval of paper.
Correspondence to: James S Harrop, MD, Professor of Neurological Surgery, Department of Neurological Surgery, Thomas Jefferson University, 909 Walnut Street Second Floor, Philadelphia, PA 19107, United States. james.harrop@jefferson.edu
Telephone: +1-215-9557959 Fax: +1-215-5037007
Received: September 29, 2013
Revised: December 19, 2013
Accepted: January 13, 2014
Published online: April 18, 2014
Processing time: 232 Days and 5.6 Hours
Abstract

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.

Keywords: Evidence-based medicine; Spinal surgery; Trial design; Research; Methodology

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.