Updated guidelines covering fusion procedures for degenerative disease of the lumbar spine

(Press-News.org) Charlottesville, VA (July 1, 2014). Experts in the spine surgery community—neurosurgeons and orthopedic surgeons—banded together to evaluate the recent literature on lumbar spine fusion procedures and to publish up-to-date evidence-based recommendations on their use. The Journal of Neurosurgery: Spine is pleased to announce today's publication of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Section on Disorders of the Spine and Peripheral Nerves' updated guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. This update replaces the first set of guidelines published in the same journal in 2005.

Spinal fusion procedures constitute an established and successful therapy for patients with pain and/or neurological deficits due to degenerative diseases of the lumbar spine. It has been nine years since the original guidelines were published, and both knowledge and clinical practices change over time. The authors acknowledge, "all clinical practice guidelines are evolving documents that require periodic updating."

Similar to the first publication, the updated guidelines document is separated into parts focusing on the following topics:

1. Introduction and methodology 2. Assessment of functional outcome following lumbar surgery 3. Assessment of economic outcome 4. Radiographic assessment of the fusion status 5. Correlation between radiographic outcome and function 6. Discography for patient selection 7. Lumbar fusion for intractable low-back without stenosis or spondylolisthesis 8. Lumbar fusion for disc herniation and radiculopathy 9. Lumbar fusion for stenosis with spondylolisthesis

10. Lumbar fusion for stenosis without spondylolisthesis 11. Interbody techniques for lumbar fusion 12. Pedicle screw fixation as an adjunct to posterolateral fusion 13. Injection therapies, low-back pain, and lumbar fusion 14. Brace therapy as an adjunct to or substitute for lumbar fusion 15. Electrophysiological monitoring and lumbar fusion 16. Bone graft extenders and substitutes as an adjunct for lumbar fusion 17. Bone growth stimulators as an adjunct for lumbar fusion

The methodology used to formulate the updated guidelines differs slightly from that used in the 2005 publication. The authors state that the change was made to provide a more objective evaluation and to ease communication between subspecialty organizations. In brief, relevant papers were examined and classified according to the strength of evidence they provide. Recommendations for clinical practice were then made according to the levels of evidence on which they rest.

The topic chapters in the updated guidelines provide graded recommendations, a rationale for the procedure, the search criteria used to identify relevant literature, and a section on the scientific foundations for the recommendation. Tables summarizing salient papers in the literature and specifying the levels of evidence they provide are also included. Issues that may warrant further investigation are also listed.

In summarizing their aims, the authors state, "These guidelines are not intended to provide rigid treatment algorithms. Instead, it is hoped that this update will serve as a comprehensive review of the current state of the literature and provide the reader with a foundation to formulate an appropriate individualized treatment plan for a given patient. Furthermore it is the intent of any guideline to identify current limitations of the literature and stimulate further investigational research."

INFORMATION: For additional information, please contact: Ms. Jo Ann M. Eliason, MA, ELS(D), Communications Manager
Journal of Neurosurgery Publishing Group
One Morton Drive, Suite 200, Charlottesville, VA 22903
Email: jaeliason@thejns.org;
Phone 434-982-1209;
Fax 434-924-2702

The Journal of Neurosurgery: Spine is a monthly peer-reviewed journal focused on neurosurgical approaches to treatment of diseases and disorders of the spine. It contains a variety of articles, including descriptions of preclinical and clinical research as well as case reports and technical notes. The Journal of Neurosurgery: Spine is one of four monthly journals published by the JNS Publishing Group, the scholarly journal division of the American Association of Neurological Surgeons. Other peer-reviewed journals published by the JNS Publishing Group each month include the Journal of Neurosurgery, Neurosurgical Focus, and the Journal of Neurosurgery: Pediatrics. All four journals can be accessed at http://www.thejns.org.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 8,300 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the brain, spinal column, spinal cord, and peripheral nerves. For more information, visit http://www.AANS.org.