To the Editor: We read the recent study by Elshaug and colleagues1 with interest, but were concerned by the inclusion of radiotherapy for spinal cord disease as a potentially low-value intervention. The lack of clinical review in the identification process appears to be the key driver in coming to this erroneous conclusion.
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- 1. Elshaug AG, Watt AM, Mundy L, Willis CD. Over 150 potentially low-value health care practices: an Australian study. Med J Aust 2012; 197: 556-560. <MJA full text>
- 2. Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 2005; 366: 643-648.
- 3. Sciubba DM, Petteys RJ, Dekutoski MB, et al. Diagnosis and management of metastatic spine disease. A review. J Neurosurg Spine 2010; 13: 94-108.
- 4. Metastatic spinal cord compression: diagnosis and management of patients at risk of or with metastatic spinal cord compression. Clinical guidelines CG75. London: National Institute for Health and Clinical Excellence, 2008. http://www.nice.org.uk/CG75 (accessed May 2013).
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