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

Recommendation Regarding Impact on Clinical Practice

This study characterizes the protocol of a prospective finding of a prospective, multicenter, randomized controlled trial which is designed to compare the clinical, functional, and radiographic outcomes of patients assigned to undergo either MISS or open surgery for symptomatic lumbar instability. While this clinical trial would be expected to yield Level 1 evidence which may be useful for differentiating between these two operative techniques, at this time there is insufficient data to draw any conclusions regarding the relative efficacy of either of these procedures. Thus, until at least the preliminary results of this analysis become available, we do not believe that this investigation currently warrants any changes in clinical practice.

Ozbek Z, Ozkara E, Onner H, et al. Treatment of unstable thoracolumbar fractures: does fracture level fixation accelerate the bone healing? World Neurosurgery 2017; 107:362–370.

The thoracolumbar junction represents a transitional zone between the rigid, kyphotic thoracic spine, and the lordotic, mobile lumbar vertebrae which is predisposed to the development of traumatic injuries. The surgical stabilization of fractures in this region has changed over time with the adoption of transpedicular instrumentation, but there is still some debate regarding the extent of fixation required cranial and caudal to the zone of injury. Ozbek et al sought to compare two different surgical techniques—short segment including fractured level (SSIFL) and long segment (LS) constructs—in terms of their fusion rates as well as other secondary clinical and radiographic measures.[17]