The appropriate management of persisting pain after spine surgery: a European panel study with recommendations based...

Area of Science:

• Neurosurgery
• Pain Management
• Spine Surgery

Background:

• Management of persisting pain after spine surgery (PPSS) lacks consistent evidence-based guidelines.
• Significant variability exists in current treatment approaches for PPSS.
• Limited clinical studies support daily practice treatment choices for PPSS.

Purpose of the Study:

• To develop patient-specific recommendations for managing PPSS.
• To establish criteria for appropriate treatment selection in PPSS patients.
• To improve the consistency and quality of care for PPSS.

Main Methods:

• Utilized the RAND/UCLA appropriateness method (RUAM).
• An international multidisciplinary panel (neurosurgeons, pain specialists, orthopaedic surgeons) evaluated 210 clinical scenarios.
• Assessed appropriateness of conservative, minimally invasive, neurostimulation, and re-operation treatments on a 9-point scale.

Main Results:

• Clear and specific patterns in treatment appropriateness were identified.
• In 48% of scenarios, only one treatment option was deemed appropriate.
• Conservative treatment suits patients without clear abnormalities; neurostimulation is for neuropathic leg pain; re-operation is for recurrent issues like stenosis or instability.

Conclusions:

• An international multidisciplinary panel established criteria for appropriate PPSS treatment using RUAM.
• These criteria can aid physician education and enhance care consistency and quality.
• The findings provide a framework for evidence-based decision-making in PPSS management.