Introduction. Evolution of the Science of Practice

Abstract

T o improve the quality of neurosurgical care and produce reliable clinical research, it is necessary for neurosurgeons to collect data on patient characteristics, processes of care, and clinically meaningful outcomes, to analyze these data, and to make the analysis available to individual neurosurgeons and the neurosurgical community. This is the Science of Practice algorithm. This issue of Neurosurgical Focus addresses the evolution of the Science of Practice and how it contributes to quality improvement now and how it will expand our opportunities for clinical research in the near future.We have lived our professional lives in the era of evidence-based medicine. However, despite multiple randomized trials, numerous guideline documents, and many millions of dollars spent, we still have not been able to reach consensus on the best management for many of our neurosurgical patients. Is this because neurosurgeons are simply recalcitrant and unwilling to be convinced by data, or because the constraints of randomized trials make neurosurgeons appropriately wary of applying their conclusions to their patients? Often, it is the latter. The Science of Practice approach to quality improvement and clinical research in neurosurgery will help to address this problem by generating real-world data that neurosurgeons can accept as applicable to the management of their patients. We believe that the Science of Practice will become an ever more important aspect of evidence-based medicine.The authors have been involved in clinical research and evidence-based medicine for many years and have

Success and Failure After Surgery for Degenerative Disease of The Lumbar Spine. an Operational Definition Based on Satisfaction, Pain, and Disability

“…Our cohort includes different diseases (disc herniation, stenosis, etc…), surgical techniques, approaches, and surgeons in one single group. This is in pace with a recent tendency of the surgical literature, the so-called science of practice (34,35). With this approach, it was already demonstrated, for example, that return to work (36), improvement of pain, disability and quality of life depend more on the patients' characteristics than on thetype of approach, number of levels, the use of fusion, thesurgeon experience and other (37).…”