Evidence-based decision-making is needed for management of medical conditions. Because the volume and quality of literature varies across disorders, the levels of evidence are variable as well. Where there is high level evidence, recommendations are strong and easily acquired. Unfortunately, there are still numerous conditions where high level evidence is still developing or missing. This is true for many spinal disorders. In those circumstances where evidence is low level or absent, it can be more difficult to determine appropriateness of treatment.
Regardless of established levels of evidence, spine care providers must regularly make decisions about indications for procedures/treatment. While higher level evidence is preferred, in those areas where evidence is sparse, appropriate use criteria (AUCs) indicate reasonable care based on available evidence combined with a rigorous, transparent recommendation process and well-defined scenarios.