Michael G Kaiser
The July 2014 issue of Journal of Neurosurgery: Spine was dedicated to the American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Joint Section on Disorders of the Spine and Peripheral Nerves guideline update for fusion procedures for degenerative disease of the lumbar spine. Michael G Kaiser, former chairman of the joint section guidelines committee, reviews the key differences between the update and the original guidelines.
As medical research continues to enhance our understanding of the application and efficacy of various treatment strategies for degenerative spine disease, an update of guidelines is periodically required to incorporate the new evidence and modify or strengthen previous recommendations.
Since the current work is intended as an update, the same topics from the 2005 guidelines were selected—including an assessment of functional and radiographic outcome measures, an analysis of surgical indications, and an evaluation of the operative techniques. The value of clinical guidelines are as follows: to categorise the strength of medical evidence and identify treatment alternatives that are supported by robust evidence compared to strategies that are supported by weak or no evidence; to provide practising clinicians with a practical and concise summary of vast amounts of available information; to identify gaps in our knowledge base and stimulate future research; and to provide persuasive arguments to third party payers and policymakers about the utility of various procedures that are beneficial to patients under specific circumstances.