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Guidelines in the decision of surgical management in spine surgery.

Introduction
The spine surgeon has knowledge and skills that allow him to make decisions when performing a surgical procedure, based on the evidence and ethical values and expectations of the patient. Any surgical procedure will be preceded by a diagnosis based on four fundamental pillars: traumatic, degenerative, vertebral destruction syndrome and deformities. Once the lesion is categorized, the surgeon will use his knowledge to identify instability or neurological compromise. When performing a surgical procedure, it should be kept in mind in the transoperative the four key objectives that will count, to achieve a satisfactory management: decompress, implement, merge and correct the sagittal balance.


Objective
To analyze the fundamental criteria in decision making, for conservative or surgical management in the spine.


Results
The assessment scales and the most frequent and best practices in relation to spine surgery will be analyzed, as well as the applications that will be applied and evaluated in each particular case, which will strengthen the diagnostic impression and the value forecast.


Conclusion
Implementing the culture of using patient outcome measurements as an assessment tool helps the spine surgeon to decide on a treatment plan that can be adapted to the patient's preferences and needs. We must base our clinical objective on the stability and the neurological commitment of the patient, there being four diagnostic possibilities; which will be corrected for four fundamental objectives.