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An Evidence-Based Medicine Process to Determine Outcomes After Cervical Spine Trauma: What Surgeons Should Be Telling Their Patients

Lewkonia, Peter, MD, MSc*; DiPaola, Christian, MD; Schouten, Rowan, MBChB; Noonan, Vanessa, PhD; Dvorak, Marcel, MD; Fisher, Charles, MD, MHSc

doi: 10.1097/BRS.0b013e31825b2c10
Cervical Spine

Study Design. A systematic review of the available medical literature from 1980 to 2010 was conducted and combined with expert opinion from a recent survey of experts regarding cervical spine fractures. Using an objective, hierarchical approach, the best available evidence is presented for health-related quality-of-life outcomes for these injuries.

Objective. To provide an evidence-based set of guidelines for cervical spine injuries in order to reduce variability in the information given to patients and their families.

Summary of Background Data. Patients' expectations regarding quality-of-life outcomes are highly dependent on the information provided by surgeons early in the treatment course. Our previous work has demonstrated that there is substantial variability in what surgeons tell patients regarding outcomes of cervical spine injuries, thus patients' expectations will differ and outcomes vary.

Methods. Four common cervical spine injuries (C1 burst, Hangman fracture, odontoid fracture, and unilateral facet fracture) treated both surgically and nonsurgically were considered. We assessed the evidence regarding 5 health-related quality-of-life outcomes: time to return to work, activity level, hospital stay, the proportion of patients who are pain free and patients who have regained full range of motion at 1 year after the injury.

Results. Published outcome data were available for most injuries. Using consensus expert opinion and the literature, answers to each question were achieved. Overall, expert opinion was relatively homogeneous across injury types, suggesting that experts do not distinguish between specific injuries when advising patients of expected outcomes such as pain.

Conclusion. By overcoming gaps in the literature with consensus expert opinion, our study provides surgeons and others with evidence-based medicine guidelines for patient-centered outcomes after cervical spine injury. This information can be presented to patients to frame expectations of typical outcomes during and after treatment to optimize patient care and quality of life.

Using an evidence-based approach, expert opinion is combined with the best available evidence from the literature to produce a set of guidelines regarding health-related quality-of-life outcomes for cervical spine fractures. These guidelines may be used by any health care provider to reduce the variability in patients' expectations for recovery.

*Division of Orthopaedics, Department of Surgery, University of Calgary, Calgary, Canada

Spine Division, Department of Orthopedics, University of Massachusetts Medical Centre, Worcester, MA

Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics, University of British Columbia, Vancouver, Canada.

Address correspondence and reprint requests to Charles G. Fisher, MD, MHSc, Combined Neurosurgical and Orthopaedic Spine Program, Blusson Spinal Cord Centre, 818 West 10th Ave., Vancouver, BC, Canada, V5Z 1M9; E-mail:

Acknowledgment date: November 4, 2011. First revision date: March 28, 2012. Acceptance date: April 15, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, decision-making position.

© 2012 Lippincott Williams & Wilkins, Inc.