NASS Clinical Practice Guidelines  

NASS continues development of clinical practice guidelines related to the diagnosis and treatment of spinal disorders. Guidelines are developed as educational tools for multidisciplinary spine care professionals to improve patient care by outlining reasonable information-gathering and decision-making processes used in the management of back pain in adults.

NASS has committed substantial resources to training the NASS Evidence-based Guideline Development Committee in evidence analysis, using both face-to-face and online training, and has recently begun implementing an evidence-based guideline development methodology.  

The NASS Evidence-Based Guidelines for Multidisciplinary Spine Care currently available include:

• Diagnosis and Treatment of Degenerative Lumbar Spinal Stenosis 
  (Revised 2011) FREE DOWNLOAD
  Technical Report
  Provides evidence-based recommendations to address key clinical questions surrounding the diagnosis and treatment of degenerative lumbar spinal stenosis. The guideline is intended to reflect contemporary treatment concepts for symptomatic degenerative lumbar spinal stenosis as reflected in the highest quality clinical literature available on this subject as of July 2010. The goals of the guideline recommendations are to assist in delivering optimum, efficacious treatment and functional recovery from this spinal disorder.
  
  
• Diagnosis and Treatment of Cervical Radiculopathy from Degenerative
  Disorders   FREE DOWNLOAD
  Provides evidence-based recommendations to address key clinical questions surrounding the diagnosis and treatment of cervical radiculopathy. The guideline is intended to reflect contemporary treatment concepts for cervical radiculopathy as reflected in the highest quality clinical literature available on this subject as of May 2009. The goals of the guideline recommendations are to assist in delivering optimum, efficacious treatment and functional recovery from this spinal disorder.
  
  
• Antithrombotic Therapies in Spine Surgery FREE DOWNLOAD
  Provides evidence-based recommendations to address key clinical questions surrounding the use of antithrombotic therapies in spine surgery. The guideline is intended to address these questions based on the highest quality clinical literature available on this subject as of February 2008. The goals of the guideline recommendations are to assist in delivering optimum, efficacious treatment with the goal of preventing thromboembolic events.
  
  
• Diagnosis and Treatment of Degenerative Spondylolisthesis FREE DOWNLOAD
  Provides evidence-based recommendations to address key clinical questions surrounding the diagnosis and treatment of degenerative lumbar spondylolisthesis. The guideline is intended to reflect contemporary treatment concepts for symptomatic degenerative lumbar spondylolisthesis as reflected in the highest quality clinical literature available on this subject as of June 2007. The goals of the guideline recommendations are to assist in delivering optimum, efficacious treatment and functional recovery from this spinal disorder.
  
  
• Antibiotic Prophylaxis in Spine Surgery  FREE DOWNLOAD
  Provides evidence-based recommendations on key clinical questions concerning the use of prophylactic antibiotics in spine surgery.  The guideline is intended to address these questions based on the highest quality clinical literature available on this subject as of December 2006. The goal of the guideline recommendations are to assist in delivering optimum, efficacious treatment in regards to preventing surgical site infection.
  

For more information, please contact NASS toll-free at (866) 960-6277.

For questions about NASS guideline projects, please contact the Research Department.

  Policy for Translation of NASS Clinical Practice Guidelines Into Other Languages   

NASS is a multidisciplinary, medical specialty society dedicated to fostering the highest quality, evidence-based, and ethical spine care by promoting education, research, and advocacy.  To improve the knowledge base for the diagnosis and treatment of spine patients, NASS has undertaken a rigorous guideline development program.  NASS’ multidisciplinary guideline development team develops clinical guidelines employing an explicit and transparent evidence-based methodology. 

NASS encourages widespread circulation and implementation of the evidence-based recommendations made within NASS’ guidelines.  To this end, NASS supports the responsible translation of our clinical practice guidelines into other languages.  NASS strongly encourages the use of appropriately trained translators with an excellent knowledge of the English language, an excellent knowledge of the target language, significant experience in both languages, cultures and medicine, and ideally some content knowledge.  It is also strongly recommended that translators implement a rigorous procedure for verifying the accuracy of such translations via a multiple forward translation process or a back-translation process with careful comparisons made between documents.  Individuals interested in translating the guidelines are granted permission to do so, provided the resulting publication follows these requirements:  (1) the document carries the NASS disclaimers listed below; (2) the document clearly indicates the version of the guideline being translated either by version number or date of publication by NASS; (3) no fees are charged above those charges necessary to recoup the cost of translation.

Any translations of the NASS clinical practice guidelines should carry the following disclaimers on each page: 

Translation Disclaimer: 
Reprinted and translated with the permission of NASS. NASS does not verify, certify and is not responsible for the accuracy of any translations, and has advised any parties translating the NASS clinical practice guidelines to carefully verify the accuracy of their translations prior to publication and dissemination.

Clinical Guideline Disclaimer: 
This clinical guideline should not be construed as including all proper methods of care or excluding other acceptable methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding any specific procedure or treatment is to be made by the physician and patient in light of all circumstances presented by the patient and the needs and resources particular to the locality or institution.

In addition, NASS asks that any prospective translator complete the clinical practice guideline translation record and send a copy to NASS to keep on file so that NASS may track all translations, appropriately direct individuals to translations of interest and notify translators of content updates and revisions.

  Spine Guidelines by Other Organizations  

In addition to developing clinical practice guidelines, NASS also reviews guidelines and clinical recommendations developed by other organizations, sometimes providing an endorsement. In keeping with NASS’ Policy on the Endorsement of Clinical Guidelines, when a NASS endorsement is provided, it does not constitute support or criticism of the content, but rather endorsement of the process by which the guideline was developed. Although NASS does not endorse the content of any guidelines, NASS will include links to statements which may be of interest to NASS members.

NASS has reviewed the following guidelines and is providing a link for those who wish to review the information or contact the developing organization. 

Practice Advisory for Perioperative Visual Loss Associated with Spine Surgery
(Approved by the ASA House of Delegates on October 25, 2005)
Developed by the American Society of Anesthesiologists (ASA) Task Force on Perioperative Blindness, the purposes of this advisory are to enhance awareness of permanent impairment or total loss of sight associated with a spine procedure during which general anesthesia is administered and to reduce its frequency. The conditions addressed in this advisory are posterior ischemic optic neuropathy (PION), anterior ischemic optic neuropathy (AION) and central retinal artery occlusion (CRAO).   The advisory is available on the ASA Web site here.

Guidelines for the Performance of Lumbar Fusion for Degenerative Disease of the Lumbar Spine
(Published in Journal of Neurosurgery:  Spine, Volume 2, June 2005)
The American Association of Neurological Surgeons and Congress of Neurological Surgeons recently issued these guidelines.  Sections of the guidelines address the following:

• assessment of outcomes following lumbar fusion;
• the diagnostic modalities helpful for the pre- and postoperative evaluation of patients considered candidates for or treated with lumbar fusion;
• recommendations for specific patient populations;
• surgical adjuncts (including pedicle screws, intraoperative monitoring and bone graft substitutes).