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
- 678 Downloads
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.
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.
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.
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.
KeywordsSpine Orthopedics General surgery Back pain Neck pain
Compliance with ethical standards
The Global Spine Care Initiative and this study were funded by Grants from the Skoll Foundation and NCMIC Foundation. World Spine Care provided financial management for this project. The funders had no role in study design, analysis, or preparation of this paper.
Conflict of interest
EA declares Grants: Depuy Synthes Spine, Medtronic; speaker’s bureau: AOSpine, Zimmer Biomet. MN declares funding from Skoll Foundation and NCMIC Foundation through World Spine Care; Co-Chair, World Spine Care Research Committee, Palladian Health, Clinical Policy Advisory Board member. Book Royalties: Wolters Kluwer and Springer. Honoraria for speaking at research method courses. KR declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. RC declares funding from AHRQ to conduct systematic reviews on treatments for low back pain within last 2 years. Honoraria for speaking at numerous meetings of professional societies and non-profit groups on topics related to low back pain (no industry sponsored talks). PC is funded by a Canada Research Chair in Disability Prevention and Rehabilitation at the University of Ontario Institute of Technology, and declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. Canadian Institutes of Health Research Canada. Research Chair Ontario Ministry of Finance. Financial Services Commission of Ontario. Ontario Trillium Foundation, ELIB Mitac. Fond de Recherche and Sante du Quebec. TM declares Fellowship Grant—Medtronics. SH declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. Clinical Policy Advisory Board and stock holder, Palladian Health. Advisory Board, SpineHealth.com. Book Royalties, McGraw Hill. Travel expense reimbursement—CMCC Board.
- 1.Global Burden of Disease Study 2013 Collaborators (2015) Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England) 386:743–800. https://doi.org/10.1016/s0140-6736(15)60692-4 CrossRefGoogle Scholar
- 3.Hogg-Johnson S, van der Velde G, Carroll LJ, Holm LW, Cassidy JD, Guzman J, Cote P, Haldeman S, Ammendolia C, Carragee E, Hurwitz E, Nordin M, Peloso P (2009) The burden and determinants of neck pain in the general population: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. J Manip Physiol Ther 32:S46–S60. https://doi.org/10.1016/j.jmpt.2008.11.010 CrossRefGoogle Scholar
- 5.Carroll LJ, Hogg-Johnson S, Côté P, van der Velde G, Holm LW, Carragee EJ, Hurwitz EL, Peloso PM, Cassidy JD, Guzman J, Nordin M, Haldeman S (2008) Course and prognostic factors for neck pain in workers: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. Eur Spine J 17:93–100. https://doi.org/10.1007/s00586-008-0629-6 CrossRefPubMedCentralGoogle Scholar
- 8.Carroll LJ, Hogg-Johnson S, van der Velde G, Haldeman S, Holm LW, Carragee EJ, Hurwitz EL, Cote P, Nordin M, Peloso PM, Guzman J, Cassidy JD (2008) Course and prognostic factors for neck pain in the general population: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. Spine 33:S75–S82. https://doi.org/10.1097/BRS.0b013e31816445be CrossRefPubMedGoogle Scholar
- 10.Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, Carragee EJ, Grabois M, Murphy DR, Resnick DK, Stanos SP, Shaffer WO, Wall EM (2009) Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine 34:1066–1077. https://doi.org/10.1097/BRS.0b013e3181a1390d CrossRefPubMedGoogle Scholar
- 11.(NICE); NIfHaCE (2013) Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for treating osteoporotic vertebral compression fractures. https://www.nice.org.uk/guidance/ta279. Accessed 10 March 2017
- 12.Bono CM, Ghiselli G, Gilbert TJ, Kreiner DS, Reitman C, Summers JT, Baisden JL, Easa J, Fernand R, Lamer T, Matz PG, Mazanec DJ, Resnick DK, Shaffer WO, Sharma AK, Timmons RB, Toton JF (2011) An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J 11:64–72. https://doi.org/10.1016/j.spinee.2010.10.023 CrossRefPubMedGoogle Scholar
- 13.Kreiner DS, Hwang SW, Easa JE, Resnick DK, Baisden JL, Bess S, Cho CH, DePalma MJ, Dougherty P 2nd, Fernand R, Ghiselli G, Hanna AS, Lamer T, Lisi AJ, Mazanec DJ, Meagher RJ, Nucci RC, Patel RD, Sembrano JN, Sharma AK, Summers JT, Taleghani CK, Tontz WL Jr, Toton JF (2014) An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J 14:180–191. https://doi.org/10.1016/j.spinee.2013.08.003 CrossRefPubMedGoogle Scholar
- 14.Kreiner DS, Shaffer WO, Baisden JL, Gilbert TJ, Summers JT, Toton JF, Hwang SW, Mendel RC, Reitman CA (2013) An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J 13:734–743. https://doi.org/10.1016/j.spinee.2012.11.059 CrossRefPubMedGoogle Scholar
- 15.Matz PG, Meagher RJ, Lamer T, Tontz WL Jr, Annaswamy TM, Cassidy RC, Cho CH, Dougherty P, Easa JE, Enix DE, Gunnoe BA, Jallo J, Julien TD, Maserati MB, Nucci RC, O’Toole JE, Rosolowski K, Sembrano JN, Villavicencio AT, Witt JP (2016) Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. Spine J 16:439–448. https://doi.org/10.1016/j.spinee.2015.11.055 CrossRefPubMedGoogle Scholar
- 19.North American Spine Society (2013) Appropriate use criteria for cervical fusion. https://www.spine.org/Portals/0/Documents/ResearchClinicalCare/CervicalFusionAUC.pdf. Accessed 27 March 2017
- 20.Chou R, Hashimoto R, Friedly J, Fu R, Dana T, Sullivan S, Bougatsos C, Jarvik J (2015) AHRQ technology assessments. In: Pain management injection therapies for low back pain. Agency for Healthcare Research and Quality (US), Rockville. https://www.ncbi.nlm.nih.gov/books/NBK285206. Accessed 5 March 2017. Accessed 27 March 2017
- 21.National Institute for Health and Care Excellence (NICE) (2012) The guidelines manual. https://www.nice.org.uk/article/pmg6/chapter/1%20introduction#ftn.footnote_1. Accessed 16 May 2016
- 23.Hartl R, Joeris A, McGuire RA (2016) Comparison of the safety outcomes between two surgical approaches for anterior lumbar fusion surgery: anterior lumbar interbody fusion (ALIF) and extreme lateral interbody fusion (ELIF). Eur Spine J 25:1484–1521. https://doi.org/10.1007/s00586-016-4407-6 CrossRefPubMedGoogle Scholar
- 24.Joseph JR, Smith BW, La Marca F, Park P (2015) Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature. Neurosurg Focus 39:E4. https://doi.org/10.3171/2015.7.focus15278 CrossRefPubMedGoogle Scholar
- 25.Carreon LY, Anderson PA, Traynelis VC, Mummaneni PV, Glassman SD (2013) Cost-effectiveness of single-level anterior cervical discectomy and fusion five years after surgery. Spine (Phila Pa 1976) 38(6):471–475. https://doi.org/10.1097/BRS.0b013e318273aee2 (PubMed PMID: 22986842) CrossRefGoogle Scholar
- 28.Mannion AF, Porchet F, Kleinstuck FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009) The quality of spine surgery from the patient’s perspective. Part 1: the core outcome measures index in clinical practice. Eur Spine J 18(Suppl 3):367–373. https://doi.org/10.1007/s00586-009-0942-8 CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Klazen CA, Lohle PN, de Vries J, Jansen FH, Tielbeek AV, Blonk MC, Venmans A, van Rooij WJ, Schoemaker MC, Juttmann JR, Lo TH, Verhaar HJ, van der Graaf Y, van Everdingen KJ, Muller AF, Elgersma OE, Halkema DR, Fransen H, Janssens X, Buskens E, Mali WP (2010) Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet (London, England) 376:1085–1092. https://doi.org/10.1016/s0140-6736(10)60954-3 CrossRefGoogle Scholar
- 33.Cedraschi C, Nordin M, Haldeman S, Radhawa K, Kopansky-Giles D, Johnson CD et al (2017) The Global Spine Care Initiative: a narrative literature review and analysis of psychosocial issues in spine related disability in low- and middle-income communities. Eur Spine J (in press) Google Scholar
- 34.Ronnberg K, Lind B, Zoega B, Halldin K, Gellerstedt M, Brisby H (2007) Patients’ satisfaction with provided care/information and expectations on clinical outcome after lumbar disc herniation surgery. Spine 32:256–261. https://doi.org/10.1097/01.brs.0000251876.98496.52 CrossRefPubMedGoogle Scholar
- 37.Porchet F, Lattig F, Grob D, Kleinstueck FS, Jeszenszky D, Paus C, O’Riordan D, Mannion AF (2010) Comparison of patient and surgeon ratings of outcome 12 months after spine surgery: presented at the 2009 joint spine section meeting. J Neurosurg Spine 12:447–455. https://doi.org/10.3171/2009.11.spine09526 CrossRefPubMedGoogle Scholar