[Evidence-based spine surgery - The twilight of a myth]

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Medical Ethics

Background:

• Rising costs necessitate efficiency and quality control in spine surgery.
• Evidence-based medicine (EBM) is presented as the primary tool for improving healthcare quality.
• Spine surgery traditionally relies on empirical, experience-based treatments, diverging from EBM's population-based approach.

Purpose of the Study:

• To examine the impact of evidence-based medicine on spine surgery practices.
• To analyze the conflict between EBM's methodology and spine surgery's traditional approach.
• To evaluate the consequences of EBM on innovation and clinical judgment in spine surgery.

Main Methods:

• Critical analysis of the application of EBM principles in spine surgery.
• Review of the evidence hierarchy favored by EBM (randomized clinical trials, systematic reviews).
• Examination of the historical development and traditional practices within spine surgery.

Main Results:

• EBM, reliant on population studies, clashes with spine surgery's experience-based tradition.
• EBM is perceived as an authoritarian system driven by healthcare funders, hindering innovation.
• The dominance of EBM has marginalized individual clinical judgment and the development of new spine surgery techniques.
• Standardization of care is deemed undesirable and impractical for spine surgery patients.

Conclusions:

• The current EBM framework may be ill-suited for the complexities and innovations in spine surgery.
• The emphasis on population-based evidence risks stifling necessary advancements and personalized treatment in the field.
• A re-evaluation of EBM's application in spine surgery is needed to balance standardization with innovation and clinical expertise.