Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy

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Spine Journal Online

This evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy has several functions. It is an educational tool for both clinicians and patients, and as such, this particular guideline is intended to assist practitioners who treat patients with lumbar disc herniation with radiculopathy. This guideline also serves to focus and rate the clinical data on this topic. An evidence-based guideline such as this allows a physician access to the best and most current evidence and reduces the burden of “keeping up with the literature” that spans innumerable journals from a broad spectrum of disciplines. In addition, this evidence-based clinical guideline has the potential to improve the appropriateness and effectiveness of patient care by basing decisions on the best evidence available.

Finally, the creation of this guideline serves to identify knowledge gaps in the clinical literature on lumbar disc herniation with radiculopathy. High-quality clinical guidelines ideally identify and suggest future research topics to improve guideline development and thus patient care, as detailed in the current guideline. The complete clinical guideline summarized in this article along with extensive descriptive narratives on each topic outlining the evidence and the work group rationale for the answers to each question can be found on the NASS Web site at http://www.spine.org/Pages/PracticePolicy/ClinicalCare/ClinicalGuidlines/Default.aspx. In addition, more extensive descriptions are provided for the guideline development process used at NASS, along with all the references used in this guideline and suggestions for future research studies on delivering optimum efficacious treatment and functional recovery from this spinal disorder.

230px-LageherniaAbstract

Background context

The objective of the North American Spine Society’s (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy is to provide evidence-based recommendations to address key clinical questions surrounding the diagnosis and treatment of lumbar disc herniation with radiculopathy. The guideline is intended to reflect contemporary treatment concepts for symptomatic lumbar disc herniation with radiculopathy as reflected in the highest quality clinical literature available on this subject as of July 2011. The goals of the guideline recommendations are to assist in delivering optimum efficacious treatment and functional recovery from this spinal disorder.

Purpose

To provide an evidence-based educational tool to assist spine specialists in the diagnosis and treatment of lumbar disc herniation with radiculopathy.

Study design

Systematic review and evidence-based clinical guideline.

Methods

This guideline is a product of the Lumbar Disc Herniation with Radiculopathy Work Group of NASS’ Evidence-Based Guideline Development Committee. The work group consisted of multidisciplinary spine care specialists trained in the principles of evidence-based analysis. A literature search addressing each question and using a specific search protocol was performed on English-language references found in Medline, Embase (Drugs and Pharmacology), and four additional evidence-based databases to identify articles. The relevant literature was then independently rated using the NASS-adopted standardized levels of evidence. An evidentiary table was created for each of the questions. Final recommendations to answer each clinical question were developed via work group discussion, and grades were assigned to the recommendations using standardized grades of recommendation. In the absence of Level I to IV evidence, work group consensus statements have been developed using a modified nominal group technique, and these statements are clearly identified as such in the guideline.

Results

Twenty-nine clinical questions were formulated and addressed, and the answers are summarized in this article. The respective recommendations were graded by strength of the supporting literature, which was stratified by levels of evidence.

Conclusions

The clinical guideline has been created using the techniques of evidence-based medicine and best available evidence to aid practitioners in the care of patients with symptomatic lumbar disc herniation with radiculopathy. The entire guideline document, including the evidentiary tables, suggestions for future research, and all the references, is available electronically on the NASS Web site athttp://www.spine.org/Pages/PracticePolicy/ClinicalCare/ClinicalGuidlines/Default.aspx and will remain updated on a timely schedule.

 

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