1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and.
2Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan.
J Neurosurg Spine. 2019 Oct 1;31(4):457-463. doi: 10.3171/2019.6.SPINE19652.
The authors believe that the standardized and systematic study of immobilization techniques, diagnostic modalities, medical and surgical treatment strategies, and ultimately outcomes and outcome measurement after cervical spinal trauma and cervical spinal fracture injuries, if performed using well-designed medical evidence-based comparative investigations with meaningful follow-up, has both merit and the remarkable potential to identify optimal strategies for assessment, characterization, and clinical management. However, they recognize that there is inherent difficulty in attempting to apply evidence-based medicine (EBM) to identify ideal treatment strategies for individual cervical fracture injuries. First, there is almost no medical evidence reported in the literature for the management of specific isolated cervical fracture subtypes; specific treatment strategies for specific fracture injuries have not been routinely studied in a rigorous, comparative way. One of the vulnerabilities of an evidenced-based scientific review in spinal cord injury (SCI) is the lack of studies in comparative populations and scientific evidence on a given topic or fracture pattern providing level II evidence or higher. Second, many modest fracture injuries are not associated with vascular or neural injury or spinal instability. The application of the science of EBM to the care of patients with traumatic cervical spine injuries and SCIs is invaluable and necessary. The dedicated multispecialty author groups involved in the production and publication of the two iterations of evidence-based guidelines on the management of acute cervical spine and spinal cord injuries have provided strategic guidance in the care of patients with SCIs. This dedicated service to the specialty has been carried out to provide neurosurgical colleagues with a qualitative review of the evidence supporting various aspects of care of these patients. It is important to state and essential to understand that the science of EBM and its rigorous application is important to medicine and to the specialty of neurosurgery. It should be embraced and used to drive and shape investigations of the management and treatment strategies offered patients. It should not be abandoned because it is not convenient or it does not support popular practice bias or patterns. It is the authors' view that the science of EBM is essential and necessary and, furthermore, that it has great potential as clinician scientists treat and study the many variations and complexities of patients who sustain acute cervical spine fracture injuries.
作者认为，对颈椎创伤和颈椎骨折损伤后的固定技术、诊断方式、医疗和手术治疗策略，以及最终的结果和结果测量进行标准化和系统的研究，如果使用设计良好的基于医学证据的比较研究，并进行有意义的随访，具有一定的价值和显著的潜力，可以确定评估、特征描述和临床管理的最佳策略。然而，他们认识到，试图应用循证医学（EBM）来确定个别颈椎骨折损伤的理想治疗策略存在固有困难。首先，文献中几乎没有报道管理特定孤立型颈椎骨折亚型的医学证据；特定的骨折损伤特定治疗策略尚未以严格的、比较的方式进行常规研究。脊髓损伤（SCI）循证科学综述的一个弱点是缺乏比较人群的研究和关于特定主题或骨折模式的科学证据，无法提供 II 级或更高证据。其次，许多轻微的骨折损伤与血管或神经损伤或脊柱不稳定无关。将循证科学的应用于创伤性颈椎损伤和 SCI 患者的护理是非常宝贵和必要的。参与编写和发表两版关于急性颈椎和脊髓损伤管理的循证指南的多学科专业作者小组，为 SCI 患者的护理提供了战略指导。为该专业提供的这项专门服务是为了向神经外科同事提供支持这些患者护理各个方面的证据的定性审查。重要的是要说明并理解，EBM 科学及其严格的应用对医学和神经外科学科都很重要。它应该被接受并用于推动和塑造为患者提供的管理和治疗策略的研究。不应该因为它不方便，或者它不支持流行的实践偏见或模式而放弃它。作者认为，EBM 科学是必不可少的，而且，随着临床医生科学家治疗和研究急性颈椎骨折损伤患者的许多变化和复杂性，它具有巨大的潜力。
