Advancing Patient Care with Clinical Practice Guidelines and Appropriate Use Criteria for Osteoporotic and Neoplastic Vertebral Fractures
NASS recently released four all-new resources to aid physician decision-making for fracture cases: Appropriate Use Criteria (AUC) and Clinical Practice Guidelines (CPG) for osteoporotic and neoplastic vertebral fractures. NASS is enthusiastic about releasing these documents together. Due to the complementary nature of these projects, together these documents provide spine care providers with a broad scope of information including evidence-based recommendations and practical decision-making tools to improve patient outcomes. By integrating a multidisciplinary approach, these documents bridge gaps in clinical evidence and offer a comprehensive approach to managing vertebral fractures
Appropriate Use Criteria: A Practical Framework for Decision-Making
The AUCs for vertebral fractures provide clinicians with a structured tool to navigate complex scenarios. Utilizing a modified Delphi process, the AUC incorporates diverse expert opinions to rate various treatment scenarios as appropriate, uncertain, or rarely appropriate. This evidence-informed approach ensures guidance even in areas with limited clinical data.
The AUC for neoplastic fractures considers a broad range of treatment modalities, including medical management, radiation, surgery, cement augmentation, and ablation. Reitman emphasized the importance of the team’s multidisciplinary approach, “Where the level of evidence is not as good, and/or the scenarios are controversial, this provides important balance and content to the ratings and the discussion.” Stability, spinal stenosis with neurological changes, and prognosis were identified as the most critical factors in determining surgical appropriateness.
The AUC for osteoporotic fractures provides clarity on treatment for acute versus chronic cases. “Acute fractures were defined as a new fracture on imaging compared to recent prior studies, or presence of edema on MRI,” Reitman explained, adding that mechanical versus nonmechanical pain plays a pivotal role in determining treatment.
“This is a very practical tool,” said Reitman, highlighting its utility in guiding clinicians through real-world decision-making.
Clinical Guidelines: Evidence-Based Recommendations
The two clinical guidelines titles both emphasize robust, evidence-based recommendations for treating vertebral fractures. Rooted in comprehensive literature reviews, these guidelines aim to standardize care while addressing individual patient needs.
These guidelines offer insights into diagnostics and treatment modalities for acute fractures. “New developments continue in medical treatment for osteoporotic compression fractures in the elderly population. Evidence-based outcomes for the new developments with clear definition of the patient group is important. For each patient, the spine fracture needs to be considered within the overall patient health for best outcome.” said Charles Cho, NASS’ Clinical Practice Guidelines Chair.
For fractures caused by malignancies, the guidelines emphasize advanced imaging techniques such as MRI and PET scans to determine the extent of the damage and guide treatment. “Tumor effects in vertebrae are more about destruction, not only compression,” Cho explained. He underscored the importance of stabilizing symptomatic patients while recommending further research for asymptomatic cases.
Minimally invasive treatments also play a critical role. For patients unable to undergo open surgery, “Less invasive intervention, if possible, is very helpful,” noted Cho.
Each of the AUCs and CPGs were developed with input from a multidisciplinary group of specialists, ensuring a balanced and comprehensive perspective. “Each specialty has a unique perspective on patient treatment for the same disease process. A patient-centric evaluation tremendously benefits each patient,” Cho remarked.
This multidisciplinary approach ensures that these resources address the full spectrum of clinical scenarios, providing guidance that is both evidence-based and practical. NASS encourages its membership to explore these new resources! Access the new CPGs and AUCs on NASS’ website.