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Eur Spine J. 2018 Sep;27(Suppl 6):870-878. doi: 10.1007/s00586-017-5392-0. Epub 2018 Jan 10.

The Global Spine Care Initiative: a summary of guidelines on invasive interventions for the management of persistent and disabling spinal pain in low- and middle-income communities.

Author information

1
ARTES Spine Center, Ankara, Turkey. acaroglue@gmail.com.
2
Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA.
3
World Spine Care Europe, Holmfirth, UK.
4
Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.
5
UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada.
6
Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA.
7
Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
8
ARTES Ankara Spine Centre, Life Gaborone Hospital, Gaborone, Botswana.
9
Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, USA.
10
Department of Neurology, University of California, Irvine, Irvine, USA.
11
World Spine Care, Santa Ana, CA, USA.

Abstract

PURPOSE:

The purpose of this study was to synthesize recommendations on the use of common elective surgical and interventional procedures for individuals with persistent and disabling non-radicular/axial with or without myelopathy, radicular back pain, cervical myelopathy, symptomatic spinal stenosis, and fractures due to osteoporosis. This review was to inform a clinical care pathway on the patient presentations where surgical interventions could reasonably be considered.

METHODS:

We synthesized recommendations from six evidence-based clinical practice guidelines and one appropriate use criteria guidance for the surgical and interventional management of persistent and disabling spine pain.

RESULTS:

Lower priority surgery/conditions include fusion for lumbar/non-radicular neck pain and higher priority surgery/conditions include discectomy/decompressive surgery for cervical or lumbar radiculopathy, cervical myelopathy, and lumbar spinal stenosis. Epidural steroid injections are less expensive than most surgeries with fewer harms; however, benefits are small and short lived. Vertebroplasty should be considered over kyphoplasty as an option for patients with severe pain and disability due to osteoporotic vertebral compression fracture.

CONCLUSION:

Elective surgery and interventional procedures could be limited in medically underserved areas and low- and middle-income countries due to a lack of resources and surgeons and thus surgical and interventional procedures should be prioritized within these settings. There are non-invasive alternatives that produce similar outcomes and are a recommended option where surgical procedures are not available. These slides can be retrieved under Electronic Supplementary Material.

KEYWORDS:

Back pain; General surgery; Neck pain; Orthopedics; Spine

PMID:
29322309
DOI:
10.1007/s00586-017-5392-0

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