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Neurosurgery Contributes to Choosing Wisely Campaign

Guest Post by John Ratliff, MD, FAANS, FACS
Co-Director, Division of Spine and Peripheral Nerve Surgery
Department of Neurosurgery Stanford University Medical Center
Stanford, CA

Ratliff full image cropped to headshotThe American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) have developed set of five targeted, evidence-based recommendations regarding neurosurgical patient care. This effort was completed as part of the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely® campaign. The goal of this initiative is to identify tests and procedures that may be commonly ordered, but are not always necessary. Participating specialty societies are working with the ABIM to share this content and these recommendations widely with patients and physicians so as to encourage discussions about the physician’s role in helping patients make wise healthcare choices.

Neurosurgery’s list includes the following five recommendations:

  1. Don’t administer steroids after severe traumatic brain injury.
  2. Don’t obtain imaging (plain radiographs, magnetic resonance imaging, computed tomography [CT], or other advanced imaging) of the spine in patients with non-specific acute low back pain and without red flags.
  3. Don’t routinely obtain CT scanning of children with mild head injuries.
  4. Don’t routinely screen for brain aneurysms in asymptomatic patients without a family or personal history of brain aneurysms, subarachnoid hemorrhage (SAH) or genetic disorders that may predispose to aneurysm formation.
  5. Don’t routinely use seizure prophylaxis in patients following ischemic stroke.

Neurosurgery’s recommendations were a joint effort of the AANS/CNS Quality Improvement Workgroup, AANS/CNS Joint Guidelines Committee and neurosurgery’s seven clinical subspecialty sections — particularly the cerebrovascular, spine, and trauma sections. This list was sent to the entire AANS and CNS membership, and was refined based on the feedback provided. As the vice-chair of the Quality Improvement Workgroup, I am proud to have contributed to this important effort.

As AANS president, Robert E. Harbaugh, MD, noted in neurosurgery’s announcement, “Neurosurgeons are committed to identifying the right treatment, for the right patient, at the right time to help eliminate unnecessary procedures, optimize outcomes, and reduce healthcare costs. Participating in the Choosing Wisely initiative is a key step in this process.”

Daniel K. Resnick, MD, CNS president echoed the importance of this initiative, stating that “We anticipate that these will help neurosurgeons and their patients make informed decisions by promoting conversations about the most appropriate tests and treatments, and avoiding care whose potential harm may outweigh the benefits.”

These recommendations will be widely disseminated to consumers through the ABIM Foundation and their advocacy partners, led by Consumer Reports. To learn more about Choosing Wisely and to view the complete lists and additional detail about the recommendations and evidence supporting them, visit

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