Controversies in spine surgery—best evidence recommendations

AR VaccaroJC Eck Thieme Publishers, New York/Stuttgart, ISBN (Americas): 9781604062397, ISBN (EUR, Asia, Africa, AUS): 9781604062397, 304pp, _Price_ $139.99 This book approaches one of the

biggest problems in spine surgery: the lack of good clinical evidence. For the major part of daily routine clinical surgical practice, there is no clear evidence on which to decide to

operate or not. For example, in the case of lumbar disc herniation, which is by far the most common pathology for spine surgeons, it was not until the randomised control trial of Peul _et

al._ in 20071 that a certain benefit in early surgery compared with extended conservative treatment was shown to us. The book is divided in several distinct sections: trauma, degenerative,

technology and infection. Every individual chapter discusses one controversy and gives an overview of the available peer reviewed literature as well as the current class of evidence. In

every chapter, one or more ‘Pearl boxes’ summarise the key points. Chapter 1 gives an introduction on evidence-based medicine and discusses its problems in spine surgery, for example the

blinding (surgery versus conservative treatment) and patients’ preference for surgery. Section 2 comprises 10 chapters on spinal trauma from clearing the spine, over the management of

different fracture types in the cervical and thoracolumbar area. The strongest evidence can be found in chapter 10, however, for not giving steroids in spinal cord injury. Unexpectedly, the

NASCIS trials failed to show any benefit in giving high doses of steroids in spinal cord injury; on the contrary, more serious adverse events were observed in the treatment group. Section 3

approaches the degenerative spine in 10 chapters. Starting off with cervical myelopathy: prognostic predictions on MRI remain controversial (chapter 14), only level II studies show

improvement in outcome with early/on time surgery (chapter 13) and due to the several surgical techniques anterior and posterior, literature still not provides any evidence to go either

anterior or posterior (chapter 12). In adult-onset low-grade spondylolisthesis and refractory to medical conservative treatment (chapter 17), there is evidence that fusion results in

significant improvement versus non-operative treatment. There is, however, no consensus regarding the surgical technique. Section 4 is divided in 6 chapters including several contemporary

hot topics, ranging from rigid or dynamic plating, cervical and lumbar disc arthroplasty, the use of expensive BMPs and minimally invasive fusion. As the incidence of spinal infections is

increasing each year, either due to an increasing elderly population, more chronic immunocompromised patients or the year after year increase in instrumented spinal fusions, section 5 on

infections certainly earns its place in this book. There is level 1 and level 2 evidence that prophylactic antibiotics lower infection rates, but not on superiority of one type of

antibiotics over another. Chapter 29 on treatment options is also very interesting in showing the safe use of titanium instrumentation, although only level IV evidence. In summary, I would

recommend this book to all spine surgeons as it demonstrates how much of what we do in daily practice is not (yet) supported by high-quality literature and it certainly shows a need for

further level I and II research. REFERENCES * Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JAH, Tans JTJ _et al_. Surgery versus prolonged conservative treatment for

sciatica. _N Engl J Med_ 2007; 356: 2245–2256. Article  CAS  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Neurosurgery, University Hospital

Antwerp, Antwerp, Belgium R Rasschaert Authors * R Rasschaert View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to R

Rasschaert. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Rasschaert, R. Controversies in Spine Surgery—Best Evidence Recommendations. _Spinal Cord_

50, 85 (2012). https://doi.org/10.1038/sc.2011.140 Download citation * Published: 06 January 2012 * Issue Date: January 2012 * DOI: https://doi.org/10.1038/sc.2011.140 SHARE THIS ARTICLE

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