By: 15 April 2021
Why it’s time to back global evidence to improve outcomes for spinal patients

Everard Munting, president of EUROSPINE, talks about the growing need for an international approach to information sharing in the field of spinal surgery.

Spinal surgery has come a long way since Hippocrates proposed the first traction procedure in 390 BC. The challenges the medical fraternity faced back then were very different to those clinicians are addressing now.

Today we live in a world that often seems to place less emphasis on movement and activity than ever before and the impact on spinal health is evident to anyone working in this field.

The pandemic has only exacerbated the problem.

Research by Ofcom found adults in the UK during the lockdowns have been spending more than 40 per cent of their waking day on their devices, a trend echoed throughout the world.

This, along with our ageing population, will only contribute to the continuing issues patients experience with neck and spinal health.


Driving innovation

On the plus side, there have been huge advances made over the last four decades in minimally invasive surgical techniques. A report by Allied Market Research projects the global spinal implants and devices market will increase to over $15 billion by 2027.

This is a highly competitive market with new technologies and products being pioneered and developed all the time to increase market share and improve patient health and mobility.

However, at the moment, it’s hard for practitioners to independently determine which procedures with or without implantable devices might work best for individual patients and why. Concern about possible complications is a major worry for patients, their families and the medical profession.

But the pandemic has taught us there is a simple way to develop practices and get the right help to patients more quickly.


A global understanding

Covid-19 underlined the importance of sharing real-world evidence on the impact of health issues in the population and escalated the development of effective treatments and a vaccine.

Pooling health data on a global scale has resulted in multiple vaccinations being developed in record time and informed techniques used in intensive care, which for some patients has meant the difference between life and death.

Could it be time for a more collaborative approach to driving innovation in our specialism?

There’s a growing case for introducing an effective way for clinicians, manufacturers, health insurances – private and public – and medical regulators to amalgamate and share their collective knowledge to increase patient safety and mitigate concern.


The danger of working in siloes

The Cumberlege Review threw a spotlight on the negative impact of information siloes across healthcare and called for an end to disjointed working in the sector. A key point emphasised in the report was that better information sharing leads to better decision making and improved patient safety.

As a result, it’s now widely accepted that sharing data on a national basis is essential, as it allows doctors and surgeons to see which treatments and devices work best for which type of patient.

However, there could be even greater advantage to taking this a step further and encouraging the sharing of information on a global scale, just as the medical research teams involved in the development of Covid-19 treatments have done.

Being able to access a larger collection of data on the spinal procedures taking place and their impact on different sets of patients would provide valuable insight into the most effective ways to improve outcomes.

Surgeons could look at the experiences of patients presenting with similar clinical characteristics and being treated using a range of approaches and devices, then use this information to make informed decisions on the best course of action to take based on the latest evidence. Which procedures work best with very elderly patients and which work more effectively for the young, for example.

Being able to draw upon a much more in-depth archive of knowledge from across the world will help to identify which treatments are most likely to result in better outcomes for subgroups of patients too, such as those with kidney conditions or morbid obesity where there may be a greater risk of poorer outcomes.


Big picture thinking  

SIRIS, the Foundation for Quality Assurance in Implant Surgery in Switzerland, has already set up a national registry with the longer-term aim of gathering evidence on implant performance.

It is tracking and monitoring outcomes of patients undergoing spinal treatment. But rather than creating a new registry database, SIRIS is using EUROSPINE’s established international registry platform, Spine Tango, built on technology provided by Northgate Public Services. This means SIRIS will easily be able to compare treatments and outcomes with other international centres already participating in the Spine Tango registry.

Sharing evidence in this way will provide a much higher level of assurance and evidence than is possible on a purely national scale, arming surgeons, hospitals and medical device manufacturers with real-world evidence from around the globe to maximise the chance of achieving a positive outcome for patients.


The backbone of safety

There can be little doubt as to the complexity and multifaceted nature of spinal surgery, not only because of the patient demographics but also the evolving trends.

Various studies have shown that disc degeneration affects 96 per cent of those in their 80s and as we are all too aware, pain and impaired movement are the clinical expressions of an ageing spine. The average global age is set to reach 73 in just four years’ time, compared to 48 years in 1955, meaning more people than ever before will require spinal surgery in one form or another.

If classifying and recording the various diagnosis, along with the effectiveness of the different surgical procedures involving or not implants, was done in a more cohesive way, this would allow for a wealth of information to be captured securely within a global implant library.

With a more substantial, evidence-based approach, where data is collated from across all the different hospitals, countries and patient groups within the national registries and information is housed on an international platform, there would be greater scope for comparison and increased efficacy and safety.


Beyond a national snapshot

Powerful, actionable insight on this scale would improve research and analysis in the specialism and increase transparency. And with the right systems in place, that automatically gather and store the most appropriate data centrally, there would be no added administrative burden on individual hospitals.

A more comprehensive set of data would reduce the risk of failing implants, or poor surgical procedures being overlooked and ensure earlier action could be taken when things go wrong.

Only by pooling international knowledge will we be able to predict the long-term success of treatments, drive up clinical standards and foster patient trust by improving safety and outcomes.


Everard Munting is an orthopaedic surgeon and president of EUROSPINE, the Spine Society of Europe. For more information on the technology behind the Spine Tango registry, visit Northgate Public Services.