SPINE20 A global advocacy group promoting evidence-based spine care of value.

Purpose: The Global Burden of Diseases (GBD) Studies have estimated that low back pain is one of the costliest ailments worldwide. Subsequent to GBD publications, leadership of the four largest global spine societies agreed to form SPINE20. This article introduces the concept of SPINE20, the recommendations, and the future of this global advocacy group linked to G20 annual summits.

Cervical fusion for treatment of degenerative conditions: development of appropriate use criteria.

Background Context: High quality evidence is difficult to generate, leaving substantial knowledge gaps in the treatment of spinal conditions. Appropriate use criteria (AUC) are a means of determining appropriate recommendations when high quality evidence is lacking.

Purpose: Define appropriate use criteria (AUC) of cervical fusion for treatment of degenerative conditions of the cervical spine.

Commentary: lessons and limitations of population-based research.

Battié MC, Jones CA, Schopflocher DP, Hu RW. Health-related quality of life and comorbidities associated with lumbar spinal stenosis. Spine J 2012;12:189-95 (in this issue).

Prospective analysis of imaging prediction of pseudarthrosis after anterior cervical discectomy and fusion: computed tomography versus flexion-extension motion analysis with intraoperative correlation.

Study Design: A prospective comparison of quantitative motion analyzed (QMA) flexion/extension radiographs versus computed tomography (CT) as an analytical predictor of cervical pseudarthrosis. Intraoperative confirmation of the fusion was performed.

Objective: To prospectively compare motion analyzed flexion/extension radiographs to CT to predict pseudarthroses.

Medical errors in orthopaedics. Results of an AAOS member survey.

Background: There has been widespread interest in medical errors since the publication of To Err Is Human: Building a Safer Health System by the Institute of Medicine in 2000. The Patient Safety Committee of the American Academy of Orthopaedic Surgeons has compiled the results of a member survey to identify trends in orthopaedic errors that would help to direct quality assurance efforts.

Methods: Surveys were sent to 5540 Academy fellows, and 917 were returned (a response rate of 16.

Neurologic impairment from ectopic bone in the lumbar canal: a potential complication of off-label PLIF/TLIF use of bone morphogenetic protein-2 (BMP-2).

Background Context: Bone morphogenetic protein-2 (BMP-2) (Infuse) has been approved for use in anterior lumbar fusion in conjunction with an LT cage. However, off-label use is seen with anterior cervical fusion, posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF). The Federal Food and Drug Administration trial of BMP-2 in a PLIF application was halted because of a high incidence of ectopic bone forming in the neural canal (75%).

To err is human: quality and safety issues in spine care.

Study Design: A review of issues linking advocacy, patient safety, and quality.

Objective: To heighten awareness of patient safety issues that require ongoing advocacy efforts by physicians treating spinal disorders.

Summary Of Background Data: The 1999 Institute of Medicine report "To Err is Human.

Incidence of contraindications to total disc arthroplasty: a retrospective review of 100 consecutive fusion patients with a specific analysis of facet arthrosis.

Background Context: The role of total disc arthroplasty (TDA) in the treatment of spinal pathology is unclear. TDA has been touted as an alternative to fusion. However, not all back pain is purely discogenic in origin.

Spinal surgery and patient safety: a systems approach.

In every spinal procedure, identifying the specific patient, proper surgical site, and pathologic lesion for surgical intervention are crucial patient safety concerns. The 1999 Institute of Medicine report "To Err is Human" identified adverse events associated with surgery. Both the American Academy of Orthopaedic Surgeons and the North American Spine Society have had voluntary, systems-based programs in place for several years to address wrong patient, wrong procedure, and wrong site surgery.