Pearls and Pitfalls in Evidence Based Medicine: What We've Learned About Outcomes Research in Spine Surgery

Spine care has become increasingly evidence-based. The investigators who have generated this evidence have learned important lessons that should help guide future trials: 1. Patients will agree to enroll in studies and to be randomized; 2. Patients will crossover between treatment arms if it is an option; 3. Observational studies can provide the best answers to some questions; 4. High quality clinical research is extremely expensive and work-intensive; 5. High quality spine research is needed now more than ever. This paper reviews these issues as they have arisen in recent clinical studies.