Evidence-Based Recommendations for Spine Surgery

Alexander R. Vaccaro, MD, PhD, MBA; Charles G. Fisher, MD; Srinivas K. Prasad, MD; Alpesh A. Patel, MD, FACS; John Chi, MD, MPH; Kishore Mulpuri, MBBS, MHSc; Kenneth C. Thomas, MD, MHSc; Peter G. Whang, MD, FACS


Spine. 2020;45(21):E1441-E1448. 

In This Article

Methodological Review

The inclusion and exclusion criteria employed to identify the initial cohort were generally appropriate although only patients with distinct nerve root compression due to a herniated disc confirmed on a magnetic resonance imaging scan were deemed to be eligible for enrollment; more specifically, individuals with a herniated disc that occupied less than one-third of the spinal canal diameter or with questionable compression of the nerve root were excluded. Randomization was performed using a computer-generated program with a variable block design. Of note, both the subjects and outcome assessors were blinded to the treatment allocation throughout the entire follow-up period which was feasible because the incisions for both procedures were similar in length. Likewise, the primary and secondary outcome measures as well as the follow-up intervals were also reasonable. The data was analyzed according to the intention to treat principle and all of the statistical testing including multivariate logistic regression modeling and assessment of interactions between variables. Overall, the methodology utilized for this investigation was largely sound and there were no significant flaws in the study design.