New Guidelines Released for Diagnosing and Treating Vertebral Fractures

The North American Spine Society (NASS) has released four evidence-based documents for the diagnosis and treatment of adults with vertebral fractures.
 
Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care, led by Charles H. Cho, M.D.:

• Diagnosis and Treatment of Adults with Neoplastic Vertebral Fractures
• Diagnosis and Treatment of Adults with Osteoporotic Vertebral Compression Fractures 

Appropriate Use Criteria, led by Charles Reitman, M.D.:

• Appropriate Use Criteria for Neoplastic Vertebral Fracture
• Appropriate Use Criteria for Osteoporotic Vertebral Fracture 

As a multidisciplinary organization for spine care providers, NASS is positioned to provide specialty expertise and a real-world perspective on multidisciplinary spine care. The documents’ authors represent various healthcare sectors, including neurosurgery, orthopedic surgery, physical medicine and rehabilitation, chiropractic care, physical therapy, anesthesiology, research, radiology, and nursing.
 
The Clinical Guidelines provide evidence-based recommendations to address key clinical questions surrounding each topic. The Diagnosis and Treatment of Adults with Neoplastic Vertebral Fractures includes 22 clinical questions with 20 recommendation statements. The Diagnosis and Treatment of Adults with Osteoporotic Vertebral Compression Fractures guideline includes 29 clinical questions with 70 recommendation statements. Each recommendation earned a grade from the work group depending on the strength of the available scientific evidence:

A = Recommended
B = Suggested
C = May be Considered
I = Insufficient or Conflicting Evidence
 
Each Clinical Guideline is divided into the seven different sections: Natural History, Cost Effectiveness, Clinical Diagnosis, Medical Treatment, Imaging Diagnosis, Interventional Treatment, and Surgical Treatment.
 
“The definition of acute compression fracture in these guidelines now incorporates clinical evaluation and imaging findings rather than timing of the fracture,” Dr. Cho explained. “This will help select all the patients with acute fractures that can benefit from intervention and it will also include those patients who continue to have pain despite prolonged duration of symptoms.”
 
The Clinical Guidelines provide recommendations based on a strict analytical process, and the strength of the recommendations are based solely on the quality of the literature for each developed question. Through a comprehensive literature review and an extensive vetting process, the guidelines provide recommendations where high-quality evidence exists and highlight knowledge gaps to guide future research. They do not answer questions for which there is little or no evidence.
 
While high-level evidence for treating spinal disorders is ideal, it is often not available. NASS concurrently developed Appropriate Use Criteria (AUC) to determine appropriate (or reasonable) recommendations regardless of the available level of evidence. Through a rigorous, transparent process including a literature search, scenario writing, and rating, a multidisciplinary group developed recommendations to specify when it is appropriate to use a procedure.
 
“The CPG and AUC are tremendously complementary documents,” Dr. Reitman stated. “They not only provide the spine specialist with contemporary levels of evidence on this topic as well as key knowledge gaps, but also a validated decision-making process for the most common clinical scenarios, regardless of the available evidence. The combination of these documents makes this an extremely practical set of documents for clinical practice and for academic educational purposes.”
 
Electronic copies of the full Clinical Guideline and AUC documents are available free to the public via the NASS website. Comments or questions about NASS guidelines and AUCs can be directed to [email protected].
 
NASS is a global multidisciplinary medical organization dedicated to fostering the highest quality, ethical, value-based and evidence-based spine care through education, research and advocacy. NASS is comprised of nearly 8,000 members from several disciplines, including orthopedic surgery, neurosurgery, physiatry, radiology, anesthesiology, research and physical therapy.