Research and evidence
The evidence, including where it runs out.
Plenty of practices say they are evidence-based. The test is whether they will tell you which of your options the research actually settles, and which one comes down to judgement.
Spine surgery has a real literature behind it, and much of it is inconvenient for anyone who wants to operate. Trials have repeatedly found that the bigger operation is not the better one for the average patient, that a great many disc herniations settle without surgery, and that findings on an MRI are poor predictors of pain on their own.
Taking that seriously narrows what gets recommended. It also means being straight about the questions where good studies disagree, because a patient who is told a judgement call is settled science cannot participate in the decision.
In practice
Four decisions the evidence changes.
These are decisions Academy patients face. In each one, what the literature says moves the answer away from the more aggressive option, or narrows who the aggressive option suits.
- 01
Does a decompression need a fusion added to it?
Randomised trials have compared decompression alone against decompression plus fusion for lumbar stenosis, including in patients with a mild degenerative slip. Routinely adding the fusion did not produce better outcomes. Fusion adds operating time, hardware, a longer recovery and permanent load on the neighbouring levels. It has to be justified by something specific in the anatomy, not added as insurance.
- 02
Disc replacement or fusion in the neck?
Cervical disc replacement and anterior fusion have both been studied at long follow-up. The interesting question is not which is better in general, it is which patients are served by keeping the segment moving. That turns on the facet joints, the alignment, how many levels are involved and the specific pathology, which is why candidacy is assessed rather than assumed.
- 03
Will this disc herniation resolve on its own?
A good deal of the published work on lumbar disc herniation concerns spontaneous resorption. Herniated disc material frequently shrinks without an operation, and the larger extruded fragments are often the ones most likely to resorb. That is the evidence behind waiting, when the symptoms and the neurological exam allow waiting.
- 04
What does an MRI finding actually mean?
Degenerative findings are common in people with no pain at all, and their prevalence rises steadily with age. A finding on a film is a candidate explanation, not a diagnosis. Matching the imaging to the examination is what separates a treatable problem from an incidental one.
The record
Where the reading comes from.
Dr. Sayari has contributed to the spine literature and reviews it for others. That is the background the recommendations above are made against.
- 71Peer-reviewed publications
- 9Textbook and book chapters
- 72National and international presentations
- 2021Rush Teacher of the Year
Peer-reviewed publication
Clinical and outcomes research across cervical and lumbar spine surgery, including disc arthroplasty, minimally invasive approaches and the predictors of re-herniation after discectomy.
Editorial and peer review
Editorial board of Clinical Spine Surgery, and manuscript review for the North American Spine Surgery Journal and World Neurosurgery. Reviewing other surgeons' work is how you learn to read a study critically rather than take its abstract at face value.
Teaching
Named Teacher of the Year at Rush University Medical Center in 2021, during orthopaedic residency training there.
National and international presentation
Work presented at the Orthopaedic Research Society, the American Academy of Orthopaedic Surgeons, the North American Spine Society, and the International Society for the Study of the Lumbar Spine.
Selected publications
A sample, not the bibliography.
Weighted toward the procedures this practice performs most. The full list is available on request.
- 2026Lateral Lumbar FusionThe Spine, Chapter 10 (Elsevier)
- 2022Segmental Range of Motion Following Cervical Total Disc Arthroplasty at Long-Term Follow-Up: A Systematic Review and Meta-AnalysisJournal of Neurosurgery: Spine
- 2022Endplate abnormalities, Modic changes and their relationship to alignment parameters and surgical outcomes in the cervical spineJournal of Orthopaedic Research
- 2022Stand-Alone Cage versus Anterior Plating for One- and Two-Level Anterior Cervical Discectomy and Fusion: A Randomized Controlled TrialClinical Spine Surgery
- 2021Artificial intelligence predicts disk re-herniation following lumbar microdiscectomy: development of the “RAD” risk profileEuropean Spine Journal
- 2021Novel Inflammation-Preserving Treatment for Symptomatic Lumbar Disc Herniation: a Prospective Imaging and Clinical Outcomes StudyEuropean Spine Journal
- 2021Spontaneous Resorption of Lumbar Disc Herniation: epidemiology, risk factors, mechanisms, and future directionsJBJS Reviews
- 2021Artificial Intelligence in Spine Care: Current Applications and Future UtilityEuropean Spine Journal
- 2019Review of Robotic-Assisted Surgery: What the Future Looks Like Through a Spine Oncology LensAnnals of Translational Medicine
Dr. Sayari writes at greater length about individual studies and how he weighs them at sayarimd.com. This page covers how that reading changes what Academy patients are offered.