NASS is Latest Group to Oppose Interventional Spine Procedures Guideline

The North American Spine Society (NASS) and 33 other medical societies worldwide have issued a formal response to recent publications in The BMJ that question the efficacy of interventional spine procedures for chronic pain.

The multi-society letter, drafted by the International Pain and Spine Intervention Society, highlights serious methodological flaws in The BMJ’s systematic review and clinical practice guideline. The letter makes several recommendations to the journal and requests the guideline be retracted over its misleading conclusions and potential harm to patient care.

The full multi-society response can be viewed at https:// www.ipsismed.org/resource/resmgr/advocacy/25/Multisociety_Statement_on_BM.pdf.  

The BMJ’s network meta-analysis aggregates data across diverse patient populations, spinal conditions and treatment techniques in ways that violate established standards for meta-analysis. The guideline, which relies on this flawed review, further compounds these issues, and the accompanying editorial reinforces its misleading conclusions.

Key concerns raised by the various organizations include:

• Flawed data aggregation: The BMJ’s systematic review combines studies of vastly different patient populations, spinal regions and procedures, creating unreliable conclusions.
• Omissions and inaccuracies: The review excludes critical high-quality studies that support the effectiveness of interventional spine procedures. Data extraction errors further cast doubt on its findings.
• Technical misinterpretation: The publications fail to recognize procedural nuances, such as variations in injection techniques and radiofrequency neurotomy standards, which significantly impact treatment outcomes.
• Patient-centered care overlooked: Interventional procedures are not a one-size-fits-all solution, but they play a vital role in multimodal pain management strategies. The BMJ’s recommendation dismisses the complexities of individual patient needs and preferences.

Protecting Patient Access to Evidence-Based Pain Management

Interventional spine procedures reduce pain, improve function, and help patients return to work. They can delay or prevent the need for surgery or long-term opioid use. The BMJ guideline’s blanket recommendation against these treatments could result in patients being denied access to safe, effective and minimally invasive care.

Given the serious methodological flaws and potential policy consequences, NASS, along with the other participating societies, urges The BMJ to retract the clinical guideline and issue corrections to the network meta-analysis. These actions are essential to maintain scientific accuracy and protect patient care.

NASS is a global multidisciplinary medical organization dedicated to fostering ethical, evidenced-based and value-based spine care by promoting 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.