Challenges in clinical guideline development in spine surgery.
| Challenge | Description |
| Evidence quality | Lack of high-quality evidence with few randomized controlled trials due challenges to conduct them in surgical settings due to ethical, logistical, and financial constraints. Double blinding is impractical. |
| Variability | Standardizing recommendations is difficult due to differences in age, health status, and specific spinal pathologies. |
| Bias | Individual or group biases from professional training, personal experience, or potential conflicts of interest (eg, financial ties to medical device manufacturers) may exist. |
| Rapid advancement | The rapid innovation cycle may outpace the slow process of traditional guideline development, leading to outdated recommendations by the time they are published. |
| Financial implications | Guidelines can have significant economic consequences in health care systems and affect reimbursement rates. This dynamic may influence the recommendations in ways that are not purely evidence-based. |
| Multidisciplinary approach | Due to the multidisciplinary nature of spine care, achieving consensus in such a diverse group of professionals can be difficult. |
| Stakeholder involvement | Incorporating the perspectives of patients, caregivers, and other stakeholders is not always prioritized in traditional processes. |
| Implementation challenges | Implementation barriers due to lack of awareness, disagreement with the recommendations, or systemic barriers in health care settings may exist. |
| Overgeneralization | The diverse nature of spinal conditions may prevent the generalization of guidelines which may run counter to personalized or precision medicine approaches. |
| Review and update | Regularly reviewing and timely updating guidelines is important given the rapid advancements in spine surgery. |
| Development cost | Systematic reviews, expert panel meetings, and other resource-intensive steps are costly |