title: The problems and limitations of applying evidence-based medicine to primary surgical treatment of adult spinal deformity.
abstract: METHODS
  : Assessment of peer-reviewed literature and personal experience with publications and grant organization.
  
  
  OBJECTIVE
  : This is an analysis of the current status of evidence-based medicine for primary adult spinal deformity to answer the question of whether surgical treatment benefits patients.
  
  
  BACKGROUND
  : A limited number of evidence-based studies have been performed for primary adult scoliosis and spinal deformity surgery. None of these studies is ideal.
  
  
  METHODS
  : This is an assessment of current literature and study group methodology in an attempt to provide an evidence-based medicine approach for the study of primary presentation adult scoliosis and related spinal deformity.
  
  
  RESULTS
  : Many reasonable studies exist; however, there are no current definitive studies that answer the question posed above. There are many obstacles, both financial and organizational, to producing an "ideal" study. Most smaller studies suggest that surgical treatment of primary adult scoliosis benefits the patient. However, there is no multicenter prospective randomized study to answer this question.
  
  
  CONCLUSIONS
  : A multicenter funded study is needed to answer appropriate questions.
authors.affiliation: Washington University, St. Louis, One Barnes-Jewish Hospital Plaza, Suite 11300 WP, Campus Box 8233, St. Louis, MO 63110, USA. bridwellk@wudosis.wustl.edu
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: Sigurd
authors.initials: S
authors.lastname: Berven
authors.forename: Charles
authors.initials: C
authors.lastname: Edwards
authors.forename: Steven
authors.initials: S
authors.lastname: Glassman
authors.forename: Christopher
authors.initials: C
authors.lastname: Hamill
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
mesh_terms: D000328:Adult; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D019637:Orthopedic Procedures / Q000379:methods*; D010380:Peer Review / Q000379:methods; D013122:Spinal Diseases / Q000453:epidemiology / Q000601:surgery*; D013131:Spine / Q000002:abnormalities* / Q000601:surgery*