Evidence-based medicine in the Spanish Spine Society

On October 20th, the 3rd Spine Pathology Update Course began. I had the honor of participating as a guest speaker to discuss one of the trending topics in research: meta-analyses. We often base our decisions on personal experience. But do we truly offer the best evidence? Learning to provide the highest level of high-quality evidence in a short time is crucial for making the best decision. «Meta-analysis refers to the statistical analysis of a large collection of results from individual studies with the purpose of integrating the findings.» The number of meta-analyses is increasing, and it is the most important tool in medical practice.

Given the amount of information and novel products in spine surgery, systematic reviews and meta-analyses have become indispensable methods for evaluating medical interventions.

With the advent of evidence-based practice (EBP) in the early 1990s, it quickly became evident that synthesized summaries of «all» evidence within a specific field would be needed, in addition to evidence from primary studies, for clinicians to make truly informed decisions. Clinical trials are often small and underpowered to detect treatment benefits.

However, there is a heated debate about the value of systematic reviews. Many believe they represent the highest level of evidence on which to base treatment recommendations. Although some controversy remains, most agree that the scientific quality of a review is closely linked to the reduction of biases inherent in this form of research. Publication bias can occur when non-significant studies are not published or when the authors of the systematic review do not perform a literature search. Selection bias occurs when the selection of studies for inclusion in the review is influenced by factors such as results, authors, or some other factor.

Systematic reviews have also been criticized for pooling data from a heterogeneous sample of studies (with different case definitions, disease severity, or comorbidities). Nevertheless, this type of research is necessary to help clinicians continually provide evidence-based medicine.