The Impact of Evidence-Based Medicine in Thoracolumbar Trauma

The past few decades have seen remarkable advancement in the evaluation, treatment, and rehabilitation of injuries to the spine and spinal cord. The development of new surgical techniques, imaging modalities, diagnostic classification systems, and biological materials gives cause for hope of improved patient outcomes following spinal trauma. Despite this progress in the understanding and treatment of thoracolumbar trauma, the topic remains one of considerable controversy. Historically, advances in spine surgical care were introduced to clinical practice without definitive empirical proof of improved clinical outcomes.1 Evidence-based approaches to the treatment of thoracolumbar spinal trauma are becoming increasingly prevalent as physicians, patients, and policy makers seek scientifically grounded data of improved and cost-effective patient care. Evidence-based medicine (EBM) is defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”2 Evidence-based medicine is not merely the use of the latest clinical evidence, but rather the integration of this information with clinical expertise, critical judgment, and the patient’s individual needs.3 Such a realistic evidence-based approach is currently being applied to answer important clinical questions, such as the effect of early versus late surgical decompression on neurological recovery, as well as the comparison of operative versus nonoperative treatment in thoracolumbar fractures.4 Moreover, evidence-based techniques are also being utilized to validate the development of new surgical interventions. Large, multicenter clinical trials are under way to definitively address the important questions regarding thoracolumbar spine trauma, a field whose research has been characterized as persistently lacking statistical power.4,5 This chapter addresses the contributions of EBM over the last few decades on a variety of treatment aspects of thoracolumbar trauma. ◆ Initial Treatment and Examination of Thoracolumbar Trauma