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European Spine Journal
Published in: European Spine Journal 6/2018

01-09-2018 | Review Article

The Global Spine Care Initiative: a systematic review for the assessment of spine-related complaints in populations with limited resources and in low- and middle-income communities

Authors: Margareta Nordin, Kristi Randhawa, Paola Torres, Hainan Yu, Scott Haldeman, O’Dane Brady, Pierre Côté, Carlos Torres, Michael Modic, Rajani Mullerpatan, Christine Cedraschi, Roger Chou, Emre Acaroğlu, Eric L. Hurwitz, Nadège Lemeunier, Jean Dudler, Anne Taylor-Vaisey, Erkin Sönmez

Published in: European Spine Journal | Special Issue 6/2018

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Abstract

Purpose

The purpose of this systematic literature review was to develop recommendations for the assessment of spine-related complaints in medically underserved areas with limited resources.

Methods

We conducted a systematic review and best evidence synthesis of guidelines on the assessment of spine-related complaints. Independent reviewers critically appraised eligible guidelines using the Appraisal of Guidelines for Research and Evaluation-II criteria. Low risk of bias clinical practice guidelines was used to develop recommendations. In accordance with the mandate of the Global Spinal Care Initiative (GSCI), recommendations were selected that could be applied to medically underserved areas and low- and middle-income countries by considering the limited access and costs of diagnostic technologies.

Results

We screened 3069 citations; 20 guidelines were eligible for critical appraisal. We used 13 that had a low risk of bias that targeted neck and back pain.

Conclusions

When assessing patients with spine-related complaints in medically underserved areas and low- and middle-income countries, we recommend that clinicians should: (1) take a clinical history to determine signs or symptoms suggesting serious pathology (red flags) and psychological factors (yellow flags); (2) perform a physical examination (musculoskeletal and neurological); (3) do not routinely obtain diagnostic imaging; (4) obtain diagnostic imaging and/or laboratory tests when serious pathologies are suspected, and/or presence of progressive neurologic deficits, and/or disabling persistent pain; (5) do not perform electromyography or nerve conduction studies for diagnosis of intervertebral disc disease with radiculopathy; and (6) do not perform discography for the assessment of spinal disorders. This information can be used to inform the GSCI care pathway and model of care.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.
Appendix
Available only for authorised users
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Metadata
Title
The Global Spine Care Initiative: a systematic review for the assessment of spine-related complaints in populations with limited resources and in low- and middle-income communities
Authors
Margareta Nordin
Kristi Randhawa
Paola Torres
Hainan Yu
Scott Haldeman
O’Dane Brady
Pierre Côté
Carlos Torres
Michael Modic
Rajani Mullerpatan
Christine Cedraschi
Roger Chou
Emre Acaroğlu
Eric L. Hurwitz
Nadège Lemeunier
Jean Dudler
Anne Taylor-Vaisey
Erkin Sönmez
Publication date
01-09-2018
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue Special Issue 6/2018
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-017-5446-3

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