J Korean Soc Spine Surg.  2011 Sep;18(3):174-178.

Evidence Based Medicine in Spine Surgery

• Park BC

Abstract

STUDY DESIGN: A review of literature regarding evidence-based medicine in spinal surgery.
OBJECTIVES
To understand the philosophy of evidence-based medicine (EBM) in order to support clinical decision making. SUMMARY OF LITERATURE REVIEW: Evidence-based medicine is a commonplace phrase representing the hallmark of excellence in clinical practice. However, there has been misunderstanding and indiscriminate use of the concept of EBM in clinical practice. It is necessary to understand true philosophy of EBM.
MATERIALS AND METHODS
Narrative and review of the literature.
RESULTS
EBM is not for research to supplant individual clinical experience and the patients' informed preference but to integrate these factors with the best available research.
CONCLUSIONS
Treatment recommendations are no longer based on level of evidence, but also the risk benefit ratio and cost effectiveness.

Keyword

Evidence-based medicine; Spine surgery

MeSH Terms

Cost-Benefit Analysis
Decision Making
Evidence-Based Medicine
Philosophy
Spine

Figure

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  Fig. 1. Hierarchy of research designs in evidence-based medicine.

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  Fig. 2. Diagram showing basic design of case-control study. Study groups are determined by outcomes: Patients with a particular outcome are cases, whereas patients without the outcome are controls. This study design looks retrospectively to determine if there is a difference in rate of exposure to a particular variable between cases and controls.

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  Fig. 3. Diagram showing basic design of observational cohort study. Treatment is chosen by patient and physician rather than through randomization. Study groups are defined by treatment, and outcomes are compared. Cohort studies can be prospective or retrospective

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  Fig. 4. Diagram showing basic design of randomized controlled trial. Study sample is randomized to different treatments, and outcomes are prospectively determined

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