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 journalArticle

9 Citations (Scopus)

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)1-9
Number of pages9
JournalEuropean Spine Journal
DOIs
StateAccepted/In press - Jan 10 2018

Fingerprint

Spine
Guidelines
Spinal Cord Diseases
Pain
Spinal Stenosis
Medically Underserved Area
Elective Surgical Procedures
Kyphoplasty
Spinal Fractures
Vertebroplasty
Epidural Injections
Compression Fractures
Diskectomy
Radiculopathy
Critical Pathways
Neck Pain
Evidence-Based Practice
Back Pain
Practice Guidelines
Osteoporosis

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

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

In: European Spine Journal, 10.01.2018, p. 1-9.

Research output: Contribution to journalArticle

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