Review ArticleAn evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy
Introduction
In an attempt to improve and evaluate the knowledge base concerning the diagnosis and treatment of lumbar disc herniation with radiculopathy, the Lumbar Disc Herniation with Radiculopathy Work Group of the North American Spine Society's (NASS) Evidence-Based Clinical Guideline Development Committee developed an evidence-based clinical guideline on this topic. The Institute of Medicine has defined a clinical guideline as “systematically developed statements to assist practitioner and patient decisions about health care for specific clinical situations” [1].
The application of the principles of evidence-based medicine (EBM) to guideline development helps to create an explicit linkage between the final recommendations in the guideline and the evidence on which these recommendations are based [2]. When employing the principles of EBM, the clinical literature is extensively searched to answer specific questions about a disease state or medical condition. The literature that is identified in the search is then rated as to its scientific merit using levels of evidence, determined by specific rule sets that apply to human clinical investigations. The specific questions asked are then answered using studies of the highest possible levels of evidence that have been obtained from the searches. As a final step, the answers to the clinical questions are reformulated as recommendations that are assigned grades of strength related to the best clinical evidence available at the time of answering each question. The intent of the grade of recommendation is to indicate the strength of the evidence used by the work group in answering the question asked.
Section snippets
Methods
For this clinical guideline, the guideline development process was broken down into 11 steps. In Step 1, guideline participants, trained in the principles of EBM, submitted a list of clinical questions focused on diagnosis and treatment of lumbar disc herniation with radiculopathy that the guideline should address. Step 2 consisted of assigning work group members to a set of clinical questions. Step 3 consisted of each group identifying appropriate search terms and parameters to direct the
Definition and natural history
Question 1: what is the best working definition of lumbar disc herniation with radiculopathy?
Localized displacement of disc material beyond the normal margins of the intervertebral disc space resulting in pain, weakness, or numbness in a myotomal or dermatomal distribution.
Work Group Consensus Statement
Question 2: what is the natural history of lumbar disc herniation with radiculopathy?
In the absence of reliable evidence relating to the natural history of lumbar disc herniation with
Discussion
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
Author disclosures:
DSK: Nothing to disclose. SWH: Nothing to disclose. JEE: Stock Ownership: Janus Biotherapeutics (E, Paid directly to institution). DKR: Board of Directors: NASS Board of Directors (Research Council Director) (None), Congress of Neurological Surgeons President Elect (None); Scientific Advisory Board/Other Office: Neurosurgical Research Foundation (None); Grants: AANS Spine Section Grant (D, Paid directly to institution/employer). JLB: Support for travel to meetings for the study or other
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Author disclosures: Listed at the end of this article.