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Robert F. Heary and Paul M. Arnold

Bakhsheshian et al. present a review paper evaluating the current state of evidence-based medicine in the nonoperative management of traumatic thoracolumbar burst fractures. 1 They performed a systematic review according to the Cochrane guidelines. This paper is very well written. They identified 45 papers, over 20 years, which primarily investigated nonoperative management, and found 9 of the 45 papers had either Level I or II evidence. The authors have comprehensively reviewed these 9 papers. They excluded papers that assessed osteoporotic or

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Mark N. Hadley and Beverly C. Walters

T he authors have long been students, practitioners, and promoters of evidence-based medicine (EBM)—or as we prefer to call it, “evidence-based methodology”—in neurological surgery, one for 25 years (M.N.H.), and the other experienced and well-versed author (B.C.W.) for almost 40 years. We believe that the standardized and systematic study of immobilization techniques, diagnostic modalities, medical and surgical treatment strategies, and ultimately outcomes and outcome measurement after cervical spinal trauma and cervical spinal fracture injuries, if performed

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Steven N. Kalkanis, Christopher I. Shaffrey, Ganesh Rao, Shelly D. Timmons, Brian L. Hoh, and John A. Wilson

TO THE EDITOR: As representatives of the leadership in organized neurosurgery, we are writing to commend the Journal of Neurosurgery: Spine for the invited publication by Hadley and Walters 1 in the October 2019 issue ( Hadley MN, Walters BC. The case for the future role of evidence-based medicine in the management of cervical spine injuries, with or without fractures. JNSPG 75th Anniversary Invited Review Article. J Neurosurg Spine . 2019;31(4):457–463 ). You chose two of our current neurosurgical thought leaders who are at the forefront of education and

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Charles G. Fisher, Tony Goldschlager, Stefano Boriani, Peter Paul Varga, Laurence D. Rhines, Michael G. Fehlings, Alessandro Luzzati, Mark B. Dekutoski, Jeremy J. Reynolds, Dean Chou, Sigurd H. Berven, Richard P. Williams, Nasir A. Quraishi, Chetan Bettegowda, and Ziya L. Gokaslan

evidence-based medicine. 15 Most of the research to date has stemmed from case reports or case series. When larger cohort studies have been performed, the cohorts are heterogeneous, representing an array of tumor histotypes, each with distinct biological and clinical characteristics, and thus limiting conclusions. Conducting the necessary studies is arduous, as PTSs are rare, treatment is varied and multidisciplinary, and the staging, classifications, and definitions are inconsistently used and ambiguous. 29 Furthermore, correlating clinical parameters and outcomes

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Rowan Schouten, Peter Lewkonia, Vanessa K. Noonan, Marcel F. Dvorak, and Charles G. Fisher

similar for expectations regarding pain freedom regardless of injury, with predictions falling within a narrow range of 56%–62%, despite wide individual variation. Although the synthesis of best available literature and expert opinion reflects the optimal evidence-based medicine methodology for determining functional prognosis after thoracolumbar trauma, there are many limitations inherent to this study. These outcome predictions are limited by the quality and quantity of the research available. They also evolved from very specific case scenarios, with the specificity

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Jacob R. Lepard, Christopher D. Shank, Bonita S. Agee, Mark N. Hadley, and Beverly C. Walters

I n the last several decades the neurosurgical community has demonstrated a continually growing commitment to the principles of evidence-based medicine (EBM) and patient care. Within neurosurgical training programs today, there is a growing trend to establish these foundational principles early in residency. Indeed, the Accreditation Council for Graduate Medical Education (ACGME) core curriculum states that “residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the

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Robert E. Harbaugh

our field to advance dramatically over the last 100 years, demonstrating the limited role of randomized controlled trials (RCTs) in establishing the effectiveness of procedural interventions. 16 However, in our present evidence-based medicine (EBM) algorithm, non-RCT studies, including registries, are viewed disparagingly. The EBM algorithm created a hierarchy of clinical data, with data from RCTs sitting atop the hierarchy. 3 However, despite decades of investment in EBM and the proliferation of evidence-based guidelines, neurosurgeons have not been able to agree

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Shobhan Vachhrajani, Abhaya V. Kulkarni, and John R. W. Kestle

databases such as MEDLINE, EMBASE, the American College of Physicians Journal Club, the British Medical Journal Clinical Evidence, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Registry, Cochrane Review Methodological Database, The National Health Service Database of Abstracts of Reviews of Effect, and Evidence-Based Medicine Reviews. Certain limits to article inclusion should also be predefined, such as language of publication, patient population, study design, types of outcome reported, and year of publication. Consideration should be paid to

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Kanna K. Gnanalingham, James Tysome, Juan Martinez-Canca, and Sinan A. Barazi

patients and subsequently related to their clinical condition. 16, 24 Other article types such as editorials, abstracts from society meetings, letters of correspondence, topic reviews (reviews or expert opinions, without critical appraisal of evidence), animal experiments, and other laboratory-based studies unrelated to the clinical care of patients were not considered in this study. 16, 24 For each of the articles, the featured study type was categorized as described previously by the National Health Service Centre for Evidence Based Medicine ( Table 1 ). 4, 20 In

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Mark Bernstein and Ross E. G. Upshur

Westernised nations. BMC Med Ethics 3 : 2 , 2002 Goodyear-Smith F, Lobb B, Davies G, et al: International variation in ethics committee requirements: comparisons across five Westernised nations. BMC Med Ethics 3: 2, 2002 28. Guyatt GH , Sackett DL , Cook DJ : Users' guides to the medical literature. II. How to use an article about therapy or prevention A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA 270 : 2598 – 2601 , 1993 Guyatt GH, Sackett DL, Cook DJ: Users' guides to the