Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain

D Scott Kreiner¹, Paul Matz², Christopher M Bono³, Charles H Cho⁴, John E Easa⁵, Gary Ghiselli⁶, Zoher Ghogawala⁷, Charles A Reitman⁸, Daniel K Resnick⁹, William C Watters 3rd¹⁰, Thiru M Annaswamy¹¹, Jamie Baisden¹², Walter S Bartynski¹³, Shay Bess¹⁴, Randall P Brewer¹⁵, R Carter Cassidy¹⁶, David S Cheng¹⁷, Sean D Christie¹⁸, Norman B Chutkan¹⁹, Bernard Allan Cohen²⁰, Simon Dagenais²¹, Dennis E Enix²², Paul Dougherty²³, S Raymond Golish²⁴, Padma Gulur¹³, Steven W Hwang²⁵, Cumhur Kilincer²⁶, Jeffrey A King¹², Adam C Lipson²⁷, Anthony J Lisi²⁸, Richard J Meagher²⁹, John E O'Toole³⁰, Paul Park³¹, Murat Pekmezci³², Daniel R Perry³³, Ravi Prasad³⁴, David A Provenzano³⁵, Kris E Radcliff³⁶, Gazanfar Rahmathulla³⁷, Tom E Reinsel³⁸, Robert L Rich Jr³⁹, Daniel S Robbins⁴⁰, Karie A Rosolowski⁴¹, Jonathan N Sembrano⁴², Anil K Sharma⁴³, Alison A Stout⁴⁴, Christopher K Taleghani⁴⁵, Ryan A Tauzell⁴⁶, Terry Trammell⁴⁷, Yakov Vorobeychik⁴⁸, Amy M Yahiro⁴¹

Affiliations

¹ Barrow Neurological Institute, 4530 E. Muirwood Dr. Ste. 110, Phoenix, AZ 85048-7693, USA. Electronic address: scott.kreiner@barrowbrainandspine.com.
² Advantage Orthopedics and Neurosurgery, Casper, WY, USA.
³ Massachusetts General Hospital, Boston, MA, USA.
⁴ Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Michigan State University, Holland, MI, USA.
⁶ Denver Spine Surgeons, Greenwood Village, CO, USA.
⁷ Lahey Hospital and Medical Center, Burlington, MA, USA; Tufts University School of Medicine, Boston, MA, USA.
⁸ Medical University of South Carolina, Charleston, SC, USA.
⁹ University of Wisconsin, Madison, WI, USA.
¹⁰ Institute of Academic Medicine Houston Methodist Hospital, Houston, TX, USA.
¹¹ VA North Texas Health Care System, UT Southwestern Medical Center, Dallas, TX, USA.
¹² Medical College of Wisconsin, Milwaukee, WI, USA.
¹³ Duke University, Durham, NC, USA.
¹⁴ Denver International Spine Center, Denver, CO, USA.
¹⁵ River Cities Interventional Pain Specialists, Shreveport, LA, USA.
¹⁶ University of Kentucky College of Medicine, Lexington, KY, USA.
¹⁷ University of Southern California, Los Angeles, CA, USA.
¹⁸ QE II Health Sciences Centre, Halifax NS B3H 3A7, Canada.
¹⁹ The CORE Institute, Phoenix, AZ, USA.
²⁰ Neurological Monitoring Associates, LLC, Milwaukee, WI, USA.
²¹ Spine Research LLC, Winchester, MA, USA.
²² Ballwin, Missouri.
²³ VA Finger Lakes Healthcare System, Canandaigua, NY, USA.
²⁴ Jupiter Medical Center, Jupiter, FL, USA.
²⁵ Shriners Hospital for Children, Philadelphia, PA, USA.
²⁶ Trakya University Faculty of Medicine, Edirne, Turkey.
²⁷ IGEA Brain & Spine, Union, NJ, USA.
²⁸ VACT Healthcare System, West Haven, CT, USA.
²⁹ Princeton Brain, Spine & Sports Medicine, Mullica Hill, NJ, USA.
³⁰ Rush University, Chicago, IL, USA.
³¹ University Of Michigan, Ann Arbor, MI, USA.
³² University of California, San Francisco, CA, USA.
³³ Choice Physical Therapy, Christiansburg, VA, USA.
³⁴ University of California, Davis, Sacramento, CA, USA.
³⁵ Pain Diagnostics and Interventional Care, Sewickley, PA, USA.
³⁶ Rothman Institute, Thomas Jefferson University, Egg Harbor Township, NJ, USA.
³⁷ University of Florida College of Medicine, Jacksonville, FL, USA.
³⁸ Huntington, WV, USA.
³⁹ Bladen Medical Associates, Elizabethtown, NC, USA.
⁴⁰ Synergy Surgicalists, Portland, ME, USA.
⁴¹ North American Spine Society, Burr Ridge, IL, USA.
⁴² University of Minnesota, Minneapolis, MN, USA.
⁴³ Spine and Pain Centers, Wall, NJ, USA.
⁴⁴ Evergreen Sport and Spine Center, Kirkland, WA, USA.
⁴⁵ Maui Brain and Spine, Wailuku, HI, USA.
⁴⁶ Choice Physical Therapy & Wellness, Christiansburg, VA, USA.
⁴⁷ Trammell Consulting LLC, Pittsboro, IN, USA.
⁴⁸ Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.

PMID: 32333996
DOI: 10.1016/j.spinee.2020.04.006

Review

Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain

D Scott Kreiner et al. Spine J. 2020 Jul.

. 2020 Jul;20(7):998-1024.

doi: 10.1016/j.spinee.2020.04.006. Epub 2020 Apr 22.

Authors

Affiliations

¹ Barrow Neurological Institute, 4530 E. Muirwood Dr. Ste. 110, Phoenix, AZ 85048-7693, USA. Electronic address: scott.kreiner@barrowbrainandspine.com.
² Advantage Orthopedics and Neurosurgery, Casper, WY, USA.
³ Massachusetts General Hospital, Boston, MA, USA.
⁴ Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Michigan State University, Holland, MI, USA.
⁶ Denver Spine Surgeons, Greenwood Village, CO, USA.
⁷ Lahey Hospital and Medical Center, Burlington, MA, USA; Tufts University School of Medicine, Boston, MA, USA.
⁸ Medical University of South Carolina, Charleston, SC, USA.
⁹ University of Wisconsin, Madison, WI, USA.
¹⁰ Institute of Academic Medicine Houston Methodist Hospital, Houston, TX, USA.
¹¹ VA North Texas Health Care System, UT Southwestern Medical Center, Dallas, TX, USA.
¹² Medical College of Wisconsin, Milwaukee, WI, USA.
¹³ Duke University, Durham, NC, USA.
¹⁴ Denver International Spine Center, Denver, CO, USA.
¹⁵ River Cities Interventional Pain Specialists, Shreveport, LA, USA.
¹⁶ University of Kentucky College of Medicine, Lexington, KY, USA.
¹⁷ University of Southern California, Los Angeles, CA, USA.
¹⁸ QE II Health Sciences Centre, Halifax NS B3H 3A7, Canada.
¹⁹ The CORE Institute, Phoenix, AZ, USA.
²⁰ Neurological Monitoring Associates, LLC, Milwaukee, WI, USA.
²¹ Spine Research LLC, Winchester, MA, USA.
²² Ballwin, Missouri.
²³ VA Finger Lakes Healthcare System, Canandaigua, NY, USA.
²⁴ Jupiter Medical Center, Jupiter, FL, USA.
²⁵ Shriners Hospital for Children, Philadelphia, PA, USA.
²⁶ Trakya University Faculty of Medicine, Edirne, Turkey.
²⁷ IGEA Brain & Spine, Union, NJ, USA.
²⁸ VACT Healthcare System, West Haven, CT, USA.
²⁹ Princeton Brain, Spine & Sports Medicine, Mullica Hill, NJ, USA.
³⁰ Rush University, Chicago, IL, USA.
³¹ University Of Michigan, Ann Arbor, MI, USA.
³² University of California, San Francisco, CA, USA.
³³ Choice Physical Therapy, Christiansburg, VA, USA.
³⁴ University of California, Davis, Sacramento, CA, USA.
³⁵ Pain Diagnostics and Interventional Care, Sewickley, PA, USA.
³⁶ Rothman Institute, Thomas Jefferson University, Egg Harbor Township, NJ, USA.
³⁷ University of Florida College of Medicine, Jacksonville, FL, USA.
³⁸ Huntington, WV, USA.
³⁹ Bladen Medical Associates, Elizabethtown, NC, USA.
⁴⁰ Synergy Surgicalists, Portland, ME, USA.
⁴¹ North American Spine Society, Burr Ridge, IL, USA.
⁴² University of Minnesota, Minneapolis, MN, USA.
⁴³ Spine and Pain Centers, Wall, NJ, USA.
⁴⁴ Evergreen Sport and Spine Center, Kirkland, WA, USA.
⁴⁵ Maui Brain and Spine, Wailuku, HI, USA.
⁴⁶ Choice Physical Therapy & Wellness, Christiansburg, VA, USA.
⁴⁷ Trammell Consulting LLC, Pittsboro, IN, USA.
⁴⁸ Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.

PMID: 32333996
DOI: 10.1016/j.spinee.2020.04.006

Erratum in

Corrigendum to "Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain" [The Spine Journal 20/7 (2020) p 998-1024].
Kreiner DS, Matz P, Bono CM, Cho CH, Easa JE, Ghiselli G, Ghogawala Z, Reitman CA, Resnick DK, Watters WC 3rd, Annaswamy TM, Baisden J, Bartynski WS, Bess S, Brewer RP, Cassidy RC, Cheng DS, Christie SD, Chutkan NB, Cohen BA, Dagenais S, Enix DE, Dougherty P, Golish SR, Gulur P, Hwang SW, Kilincer C, King JA, Lipson AC, Lisi AJ, Meagher RJ, O'Toole JE, Park P, Pekmezci M, Perry DR, Prasad R, Provenzano DA, Radcliff KE, Rahmathulla G, Reinsel TE, Rich RL Jr, Robbins DS, Rosolowski KA, Sembrano JN, Sharma AK, Stout AA, Taleghani CK, Tauzell RA, Trammell T, Vorobeychik Y, Yahiro AM. Kreiner DS, et al. Spine J. 2021 Apr;21(4):726-727. doi: 10.1016/j.spinee.2021.02.006. Epub 2021 Feb 24. Spine J. 2021. PMID: 33640275 No abstract available.

Abstract

Background context: The North American Spine Society's (NASS) Evidence Based Clinical Guideline for the Diagnosis and Treatment of Low Back Pain features evidence-based recommendations for diagnosing and treating adult patients with nonspecific low back pain. The guideline is intended to reflect contemporary treatment concepts for nonspecific low back pain as reflected in the highest quality clinical literature available on this subject as of February 2016.

Purpose: The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with nonspecific low back pain. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition.

Study design: This is a guideline summary review.

Methods: This guideline is the product of the Low Back Pain Work Group of NASS' Evidence-Based Clinical Guideline Development Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questions to address in the guideline. The literature search strategy was developed in consultation with medical librarians. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in webcasts and in-person recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guideline was submitted to an internal and external peer review process and ultimately approved by the NASS Board of Directors.

Results: Eighty-two clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature.

Conclusions: The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with nonspecific low back pain. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at https://www.spine.org/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx.

Keywords: Cost utility; Diagnosis; Evidence-based guideline; Low back pain; Lumbago; Lumbar; Lumbar pain; Lumbosacral; Prognosis; Treatment.

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Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain

Affiliations

Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain

Authors

Affiliations

Erratum in

Abstract

Publication types

MeSH terms

LinkOut - more resources

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Medical