Evidence-based Neurosurgery

Haines, Stephen J.

doi:10.1227/00006123-200301000-00004

Cited by 18 publications

(7 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A powerful RCT is the best standard for evaluating the inherent bias, but it does not follow that EBM requires only RCTs to justify clinical practice. EBM requires that we attempt to audit our decisions by obtaining the highest level of evidence that is ethically or logistically possible [24,25].…”

Section: Discussionmentioning

confidence: 99%

“…These principles are applied in light of the neurosurgeon's training and experience informed by the patient's individual circumstances and preferences to regularly produce the best possible health outcomes [1]. Although evidence-based medicine (EBM) is the golden standard in medicine [1][2][3], it is estimated that only 10 -25% of the clinical decisions are based on high-quality evidence [4].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Neurosurgery - More Eminence than Evidence: Results of an International Survey (Preprint)

Martens¹

2017

Preprint

View full text Add to dashboard Cite

BACKGROUND:The publication rate of neurosurgical guidelines has increased tremendously over the past decade. However, only a small proportion of clinical decisions appears to be based on highquality evidence. OBJECTIVE: To evaluate the available evidence within neurosurgery and its value within clinical practice according to neurosurgeons. METHODS: A web-based survey was sent to 2552 neurosurgeons, who were members of the European Association of Neurosurgical Societies. RESULTS:The response rate to the survey was 7% (173 respondents). According to 49% of the respondents, neurosurgery is based on less evidence compared with other medical specialties, and not enough high-quality evidence is available on which to base clinical practice. However, 84% of the respondents believed neurosurgery is amenable to evidence. Of the respondents, 59% considered the neurosurgical guidelines in their hospital to be based on high-quality evidence. Responders that did consider the neurosurgical guidelines in their hospital to be based on high-quality evidence did consider their own treatments more often as based on Level I and/or Level II (84% resp. 55%) (P < . 001). Also, neurosurgeons with formal training believed they could understand, criticize and interpret statistical outcomes presented in journals better than those without formal training (93% resp. 68%) (P < .001). CONCLUSION: According to the respondents, neurosurgery is based less often on high-quality evidence than other medical specialties. When looking at the results of the survey, formal training in EBM is desirable, so neurosurgeons can better understand, criticize and interpret statistical outcomes presented in journals.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neurosurgery - More Eminence than Evidence: Results of an International Survey (Preprint)

Martens¹

2017

Preprint

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4] Meta-analysis of several RCTs is a more powerful statistical technique of pooling together data from similar studies. [2][3][4] Other clinical trial designs such as cross sectional, cohort, and case-control studies, whether prospective or retrospective, suffer from the lack of randomisation, blindness, and the inclusion of control groups. Thus, these study designs are more prone to confounding influences.…”

Section: Discussionmentioning

confidence: 99%

“…Assessing the quality of this evidence, however can be challenging. [1][2][3][4] In the hierarchy of research study designs, prospective randomised controlled trials (RCT) and meta-analysis of several RCTs or other clinical trials are considered to provide the highest quality of evidence. 3 4 Other clinical trial designs such as cohort and case-control studies are more prone to bias and confounding factors.…”

mentioning

confidence: 99%

A 30 year perspective of the quality of evidence published in 25 clinical journals: Signs of change?

Gnanalingham

Robinson

Hawley

et al. 2006

Postgraduate Medical Journal

View full text Add to dashboard Cite

Methods: The quality of clinical studies published in five different specialties, over three decades was evaluated. Computerised search of the Medline database was undertaken to evaluate the articles published in 25 clinical journals in 1983, 1993, and 2003 from five different specialties (medicine, surgery, paediatrics, anaesthesia, and psychiatry). The number of randomised controlled trials (RCTs), meta-analyses, and other clinical trials (non-RCT) were noted. Results: From the 27 030 articles evaluated, there were 2283 (8.4%) RCTs, 166 (0.6%) meta-analyses, and 4153 (15.4%) other clinical trials. For the proportion of RCTs, the rank order of the specialties was; anaesthesia (503; 18%), psychiatry (294; 9.6%), medicine (899; 8.1%), paediatrics (326; 6.4%), and surgery (261; 5.3%) (p,0.001). For the proportion of meta-analysis, the rank order of the specialties was; psychiatry (36; 1.2%), medicine (105; 0.9%), paediatrics (15; 0.3%), anaesthesia (6; 0.2%), and surgery (4; 0.1%) (p,0.001). Overall, from 1983 to 2003, there were increases in the proportion of RCTs (449, 5.9% to 1027, 9.6%), meta-analysis (0, 0% to 127, 1.2%), and other clinical trials (897, 12% to 1983, 19%) (p,0.001). This trend was apparent in each clinical specialty (p,0.001). Conclusions: Over the three decades evaluated, clinical trials, notably RCTs and meta-analysis form only a small proportion of articles published in prominent journals from five clinical specialties. This is notwithstanding the modest increases in the proportions of RCTs and meta-analysis over the same period.

show abstract

“…A metaanalysis review of the literature involving a large series of published papers has been used in an attempt to produce an accurate and widebased conclusion regarding the management of the problem at hand. 19 However, the lack of well-defined studies in which investigators analyze linkage evidence prevents any quantitative analysis such as metaanalysis for this particular problem. case-control retrospective analysis of POVL after spinal surgery, in which they surveyed the members of the Scoliosis Research Society.…”

Section: Evaluation By Metaanalysismentioning

confidence: 99%

Vision loss after spine surgery: review of the literature and recommendations

Baig¹,

Lubow²,

Immesoete³

et al. 2007

Neurosurgical FOCUS

View full text Add to dashboard Cite

HE focus of this review was to present the issue of vision loss associated with modern spinal surgery. Vision loss after spinal surgery is a unique complication of optic nerve damage resulting from ION, most often located in the posterior portion of the orbital optic nerve. This is surprising because the posterior area is rarely affected by ischemia. Such "posterior" lesions are designated PION. They have been uncommon until recently, mostly found in association with lumbar spinal surgery. We present the unique factors associated with lumbar surgeries and the patients undergoing them. Vision loss linked to ION and associated with lumbar surgery should be termed LION.Of the many different complications resulting from spinal surgery, POVL is an uncommon but devastating morbidity, with dire consequences. It is estimated that 1 case per 100 spine surgeons annually will have a significant vision complication after surgery.35 Recent studies have shown that spinal surgery is the leading cause of POVL, replacing cardiac surgery. 6,37,42 Postoperative vision loss has been the subject of investigation even before the era of modern spinal instrumentation and fusion techniques. 22,41Although the number of cases reported in the literature is on the rise, many questions remain regarding its origin, risk factors, pathophysiology, and prevention. We attempt to summarize the evidence in literature, highlight the limitations of existing knowledge, and recommend practical guidelines for avoiding this outcome. Summary of Literature Search MethodologyWe searched the National Library of Medicine's PubMed using key words, with subsequent review of the accompanying references and its citations. The key words included a combinations of the following: spine and postoperative visual loss, or spinal postoperative visual loss, spine and postoperative blindness, spine/spinal and posterior ischemic optic neuropathy, spine/spinal and retrobulbar optic neuropathy or spine/spinal and ischemic optic neuropathy. In our review we included articles dealing with visual complications after spinal surgery and excluded non-English language literature and duplicate results.Using these criteria, we identified 166 cases of perioperative vision loss in 21 reports (Table 1) (Fig. 1). 1,3,5,[8][9][10]13,14,17,[25][26][27][28][29][30][31][32][34][35][36]42 Neurosurg. In recent studies spinal surgery has replaced cardiac surgery as a leading cause of postoperative vision loss (POVL). Estimates of the incidence of POVL after spinal surgery range from 0.028 to 0.2%, but with advances in complex spinal instrumentation and the rise in annual spinal operations, POVL may see an ominous increase in its incidence. Postoperative vision loss is an uncommon but devastating complication, with unknown origin and pathogenesis. The authors undertook a literature review and summarize the current understanding of its pathophysiology, highlight the limitations of existing knowledge, and recommend practical guidelines for avoiding this devastating outcome.

show abstract

Evidence-based Neurosurgery

Cited by 18 publications

References 30 publications

Neurosurgery - More Eminence than Evidence: Results of an International Survey (Preprint)

Neurosurgery - More Eminence than Evidence: Results of an International Survey (Preprint)

A 30 year perspective of the quality of evidence published in 25 clinical journals: Signs of change?

Vision loss after spine surgery: review of the literature and recommendations

Contact Info

Product

Resources

About