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

Emre Acaroğlu, Margareta Nordin, Kristi Randhawa, Roger Chou, Pierre Côté, Tiro Mmopelwa, Scott Haldeman

Research output: Contribution to journalReview article

10 Scopus citations

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. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material. [Figure not available: see fulltext.].

Original languageEnglish (US)
Pages (from-to)870-878
Number of pages9
JournalEuropean Spine Journal
Volume27
DOIs
StatePublished - Sep 1 2018

Keywords

  • Back pain
  • General surgery
  • Neck pain
  • Orthopedics
  • Spine

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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