Decision analysis of treatment choices in the osteochondroses

Physicians tend to decry the lack of data on which they can make decisions. This is commendable, and all should encourage the pursuit of better data and more precise analysis. But decisions must be made, and each physician must deal with what data are available and evaluate them against all the general uncertainties. Equally important are the values that we place on the outcome of treatment. Much of the disagreement among physicians about treatment protocols involves a difference in values. While this is not necessarily bad, it points to the need to consider explicitly the value we place on a result or the morbidity possibly accompanying that result. In the osteochondroses, consideration of values will protect patients from overzealous treatment. Finally, the formality of a decision process should not necessarily modify a plan of treatment based on fundamentally sound principles, intuition, and anecdotal experience. Regardless of which factors represent the basis for an individual surgeon's selection of a particular approach, evaluation of both desirable and undesirable aspects of each alternative prevents impulsive acceptance of the most recently described, often unproven operation. Salter's aphorism: "The decision is more important than the incision," is particularly applicable in treatment of the osteochondroses.