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

Aside from addressing a clinically meaningful question, this study has a number of significant strengths. For instance, the baseline characteristics of each group were similar across age, sex, injury classification, and body mass index. All of the subjects included in the analysis had at least 2 years of clinical and radiographic follow-up including patient reported outcome measures (i.e., VAS and ODI) and the complications observed for each group are listed. Collectively, these factors certainly enhance the potential impact of these results.

Nevertheless, there are also several important limitations to this investigation. First and foremost is the authors' definition of radiographic fusion which is based upon the amount of uptake visualized within the fractured vertebral body using Tc-99 and single photo emission computed tomography imaging which unfortunately may confuse terminology commonly used to describe fracture healing and spinal arthrodesis. As acknowledged by the authors, these specific radiographic criteria for establishing "fusion" may yield false-positive findings due to normal bone metabolic activity as opposed to a pathological state. There is no indication that a power analysis was performed in which case the data is prone to statistical errors. Likewise, the authors do not specify confidence intervals or odds ratios, making interpretation of the data more problematic.