Advertisement

European Spine Journal

, Volume 27, Supplement 6, pp 870–878 | Cite as

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
Review Article

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.

Keywords

Spine Orthopedics General surgery Back pain Neck pain 

Notes

Compliance with ethical standards

Funding

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.

Supplementary material

586_2017_5392_MOESM1_ESM.pdf (12 kb)
Supplementary material 1 (PDF 12 kb)
586_2017_5392_MOESM2_ESM.pptx (172 kb)
Supplementary material 2 (PTX 173 kb)

References

  1. 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
  2. 2.
    Maniadakis N, Gray A (2000) The economic burden of back pain in the UK. Pain 84:95–103CrossRefGoogle Scholar
  3. 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
  4. 4.
    Menezes Costa LC, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LOP (2012) The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ: Can Med Assoc J 184:E613–E624.  https://doi.org/10.1503/cmaj.111271 CrossRefGoogle Scholar
  5. 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
  6. 6.
    Cassidy JD, Carroll LJ, Cote P, Lemstra M, Berglund A, Nygren A (2000) Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury. N Engl J Med 342:1179–1186.  https://doi.org/10.1056/nejm200004203421606 CrossRefPubMedGoogle Scholar
  7. 7.
    Cassidy JD, Cote P, Carroll LJ, Kristman V (2005) Incidence and course of low back pain episodes in the general population. Spine 30:2817–2823CrossRefGoogle Scholar
  8. 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
  9. 9.
    Karadimas SK, Erwin WM, Ely CG, Dettori JR, Fehlings MG (2013) Pathophysiology and natural history of cervical spondylotic myelopathy. Spine 38:S21–S36.  https://doi.org/10.1097/BRS.0b013e3182a7f2c3 CrossRefPubMedGoogle Scholar
  10. 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. 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. 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. 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. 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. 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
  16. 16.
    Mannion AF, Brox JI, Fairbank JC (2013) Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials. Spine J 13:1438–1448.  https://doi.org/10.1016/j.spinee.2013.06.101 CrossRefPubMedGoogle Scholar
  17. 17.
    Friedly J, Standaert C, Chan L (2010) Epidemiology of spine care: the back pain dilemma. Phys Med Rehabil Clin N Am 21:659–677.  https://doi.org/10.1016/j.pmr.2010.08.002 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    AGREE (Appraisal of Guidelines R, and Evaluation in Europe) Collaborative Group (2000) Guideline development in Europe. An international comparison. Int J Technol Assess Health Care 16:1039–1049CrossRefGoogle Scholar
  19. 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. 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. 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
  22. 22.
    Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD (2009) Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine 34:1094–1109.  https://doi.org/10.1097/BRS.0b013e3181a105fc CrossRefPubMedGoogle Scholar
  23. 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. 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. 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
  26. 26.
    Buttermann GR (2017) Anterior cervical discectomy and fusion outcomes over 10 years: a prospective study. Spine (Phila Pa 1976)  https://doi.org/10.1097/BRS.0000000000002273 (Epub ahead of print, PubMed PMID: 28604488) CrossRefGoogle Scholar
  27. 27.
    Rhee JM, Shamji MF, Erwin WM, Bransford RJ, Yoon ST, Smith JS, Kim HJ, Ely CG, Dettori JR, Patel AA, Kalsi-Ryan S (2013) Nonoperative management of cervical myelopathy: a systematic review. Spine 38:S55–S67.  https://doi.org/10.1097/BRS.0b013e3182a7f41d CrossRefPubMedGoogle Scholar
  28. 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
  29. 29.
    Chou R, Hashimoto R, Friedly J, Fu R, Bougatsos C, Dana T, Sullivan SD, Jarvik J (2015) Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis. Ann Intern Med 163:373–381.  https://doi.org/10.7326/m15-0934 CrossRefPubMedGoogle Scholar
  30. 30.
    Buchbinder R, Golmohammadi K, Johnston RV, Owen RJ, Homik J, Jones A, Dhillon SS, Kallmes DF, Lambert RG (2015) Percutaneous vertebroplasty for osteoporotic vertebral compression fracture. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD006349.pub2 CrossRefPubMedGoogle Scholar
  31. 31.
    Anderson PA, Froyshteter AB, Tontz WL Jr (2013) Meta-analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures. J Bone Miner Res 28:372–382.  https://doi.org/10.1002/jbmr.1762 CrossRefPubMedGoogle Scholar
  32. 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. 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. 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
  35. 35.
    Yee A, Adjei N, Do J, Ford M, Finkelstein J (2008) Do patient expectations of spinal surgery relate to functional outcome? Clin Orthop Relat Res 466:1154–1161.  https://doi.org/10.1007/s11999-008-0194-7 CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Graz B, Wietlisbach V, Porchet F, Vader JP (2005) Prognosis or “curabo effect?”: physician prediction and patient outcome of surgery for low back pain and sciatica. Spine 30:1448–1452 (discussion 1453) CrossRefGoogle Scholar
  37. 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
  38. 38.
    Knop C, Bastian L, Lange U, Oeser M, Zdichavsky M, Blauth M (2002) Complications in surgical treatment of thoracolumbar injuries. Eur Spine J 11:214–226.  https://doi.org/10.1007/s00586-001-0382-6 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.ARTES Spine CenterAnkaraTurkey
  2. 2.Departments of Orthopedic Surgery and Environmental MedicineNew York UniversityNew YorkUSA
  3. 3.World Spine Care EuropeHolmfirthUK
  4. 4.Faculty of Health SciencesUniversity of Ontario Institute of TechnologyOshawaCanada
  5. 5.UOIT-CMCC Centre for Disability Prevention and RehabilitationTorontoCanada
  6. 6.Department of Medical Informatics and Clinical EpidemiologyOregon Health and Science UniversityPortlandUSA
  7. 7.Department of MedicineOregon Health and Science UniversityPortlandUSA
  8. 8.ARTES Ankara Spine CentreLife Gaborone HospitalGaboroneBotswana
  9. 9.Department of Epidemiology, School of Public HealthUniversity of California Los AngelesLos AngelesUSA
  10. 10.Department of NeurologyUniversity of California, IrvineIrvineUSA
  11. 11.World Spine CareSanta AnaUSA

Personalised recommendations