Health care reform will emphasize evidence-based medicine to provide the highest quality care.
Recent literature has emerged in spinal surgery that has profoundly increased the evidence base for
several spinal procedures. There is now good evidence from randomized controlled trials that
surgical treatment of symptomatic lumbar disc herniation, decompression for spinal stenosis, and
decompression and fusion for degenerative spondylolisthesis all offer significant clinical benefit
in the face of serious back and radicular pain when compared with nonsurgical care. Studies of
nonsurgical and surgical treatments for chronic low back pain are inconclusive, limited by study
design/methodology. Continuing to increase study quality in the field of spine surgery is more
important now than ever before. Optimizing diagnostic specificity, surgical indications, and
measuring outcomes with validated instruments should help the spine care community acquire essential
data to provide the highest quality evidence-based care, while simultaneously eliminating procedures
that lack evidence of efficacy or value.
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