Evidence Based Medicine is becoming steadily more important in the current neurosurgical environment. The spine section is no exception and has responded enthusiastically to the call from our national leadership for EBM studies and Guidelines development. The spine and peripheral nerve section has had a subcommittee on Outcomes that dates back more than five years. Last year guidelines covering lumbar fusion were published in the Journal of Neurosurgery: Spine and the section has currently tasked a team under the direction of Paul Matz to generate guidelines in the area of cervical spondylosis.

What then is Evidenced Based Medicine and how does it relate to the way medicine was practiced in the pre-EBM era? At its core EBM is a system for applying the relevant literature in the most appropriate way for an individual patient with a particular clinical problem. It is a formalism that stratifies the literature into different classes based on the strength of the evidence. In EBM a Randomized Controlled Trail receives more emphasis than a case report. This is very similar to the process that surgeons have been employing to make sense out of the literature long before the buzzword EBM reached such prominence. EBM is the farthest thing in the world from cook book medicine or medicine by committee. In fact, EBM readily acknowledges that expert opinion and prior clinical experience are appropriate bases for clinical decision making especially for questions in which the literature does not provide strong guidance.