Spinal disorder

Spinal disorders are widespread and affect always more people thus the entire Civil Society; back pain is the second reason responsible for absenteeism from work after the common flux. While the constant drive for the development of always more sophisticated spine surgery technologies is skyrocketing, there is no obvious additional healthcare benefit; spine surgery revision rate remains high - about 10-15% at 10 years.

The global population is currently undergoing an upward shift in its age structure due to decreasing fertility rates and increasing life expectancy. As a result, clinicians worldwide will be required to manage an increasing number of spinal disorders specific to the elderly and the aging of the spine. Elderly individuals pose unique challenges to health care systems and to spinal physicians as these patients typically have an increased number of medical comorbidities, reduced bone density mass, more severe spinal degeneration and a greater propensity to falls 1).

Value can be measured in spine care through the use of appropriate economic measures and patient-reported outcomes measures. Value must be interpreted in light of the perspective of the assessor, the duration of the assessment period, the degree of appropriate risk stratification, and the relative value of treatment alternatives.Level of Evidence: N/A 2).

The burden of spinal disorders encompasses metrics such as the prevalence of spinal disorders, the impact of spinal disorders on health-related quality of life, and the use of resources associated with the operative and nonoperative management of spinal disorders. Measurement of the burden of spinal disorders is important in prioritizing the distribution of limited resources within ther healthcare economy. In 1998, the Priority Setting Committee of the Institute of Medicine concluded that in defining health priorities for research and funding, the burden of disease and impact on the health of the population should be the primary determinants of resource allocation 3).

Spinal disorders are common and are an important cause of pain and disability. Numerous complementary and competing treatment strategies are used to treat spinal disorders, and the costs of these treatments is substantial and continue to rise despite clear evidence of improved health status as a result of these expenditures.

Nowadays, the treatment of spinal disorders is one of the most controversial and challenging topics with its significant social, ethical, economic, and political impacts; the issues deriving from spinal disorder management, qualification of spine specialists and organization of best quality spine centers must be addressed.

The choice of a surgical approach is a significant determinant of risk, cost, and outcome. Informed choice regarding a surgical approach requires participation of the patient and surgeon. Limited interventions may be appropriate for patients with radicular symptoms and focal pain. More extensive surgery may be required for patients with global imbalance of the spine. The role of minimally invasive approaches in limiting complications and improving outcome remains in evolution. An optimal choice of surgical approach requires consideration of patient preferences, values, comorbidities, and goals of care 4).

Fehlings MG, Tetreault L, Nater A, Choma T, Harrop J, Mroz T, Santaguida C, Smith JS. The Aging of the Global Population: The Changing Epidemiology of Disease and Spinal Disorders. Neurosurgery. 2015 Oct;77 Suppl 4:S1-5. doi: 10.1227/NEU.0000000000000953. PubMed PMID: 26378347.
Resnick DK, Tosteson AN, Groman RF, Ghogawala Z. Setting the Equation: Establishing Value in Spine Care. Spine (Phila Pa 1976). 2014 Oct 15;39(22S Suppl 1):S43-S50. PubMed PMID: 25299258.
Waldrop R, Cheng J, Devin C, McGirt M, Fehlings M, Berven S. The Burden of Spinal Disorders in the Elderly. Neurosurgery. 2015 Oct;77 Suppl 4:S46-50. doi: 10.1227/NEU.0000000000000950. PubMed PMID: 26378357.
Gussous Y, Than K, Mummaneni P, Smith J, Steinmetz M, Ohya J, Berven S. Appropriate Use of Limited Interventions vs Extensive Surgery in the Elderly Patient With Spinal Disorders. Neurosurgery. 2015 Oct;77 Suppl 4:S142-63. doi: 10.1227/NEU.0000000000000954. PubMed PMID: 26378352.
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