Congratulations to Dr. Michael Kaiser, Associate Professor of Neurosurgery and Associate Director of The Spine Hospital at The Neurological Institute of New York, who supervised a seventeen-part guideline update published in the July edition of The Journal of Neurosurgery: Spine, one of the preeminent peer-reviewed spine publications.
The project provides spinal surgeons with updated guidelines for lumbar fusion surgery, a commonly performed procedure to stabilize the lower spine. Although immediate stability is provided by the insertion of metallic implants, long-term success is dependent on the incorporation of bone graft into the patient’s spine. This bone graft can be harvested from a section of the patient’s pelvis, known as the iliac crest, often incorrectly interpreted as the patient’s hip.
The original set of lumbar fusion guidelines was published in The Journal of Neurosurgery: Spine in 2005. The update incorporates the most recent evidence and information made available since the original guidelines were published. “The most dramatic difference,” says Dr. Kaiser, was “in the chapter addressing bone graft extenders and substitutes”—a chapter for which Dr. Kaiser was the lead author. The current work is based on the review of nearly ten times the number of articles about bone graft extenders and substitutes reviewed for the 2005 publication.
For the guideline update, Dr. Kaiser and his colleagues elected to modify the previous method of evaluating medical evidence and utilize a more detailed and reproducible protocol. Recommendations were also presented in a more objective manner. Utilizing this strategy, the update would be more consistent with guideline efforts published by other organizations and facilitate communication between physicians from other subspecialties.
Lumbar fusion surgery has become increasingly common: between 1992 and 2003, its use tripled in patients over 65. In the same decade, the annual costs associated with the procedure rose by 500%. These surgeries are becoming increasingly complex as new techniques–like bone graft extenders and substitutes–are developed to solve recurrent problems.
In this rapidly expanding field, it is particularly important that physicians can turn to high-quality evidence when treating their patients. Dr. Kaiser hopes that he and his team of expert neurosurgical and orthopedic spine surgeons have provided such information to their colleagues. As Dr. Kaiser puts it, “It is the hope that these and future guidelines will serve as an effective summary and provide a foundation to guide practicing clinicians in formulating effective treatment plans, based not only on their experience and patient preferences, but also on the best available medical evidence.”