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Open Access Study protocol

A prospective cohort study of surgical treatment for back pain with degenerated discs; study protocol

Richard A Deyo126*, Sohail K Mirza36, Patrick J Heagerty46, Judith A Turner56 and Brook I Martin16

Author Affiliations

1 Department of Medicine. Box 359736, 325 Ninth Ave., Seattle, Washington, 98104, USA

2 Department of Health Sciences. Box 359736, 325 Ninth Ave., Seattle, Washington, 98104, USA

3 Department of Orthopedic Surgery. Box 359798, 325 Ninth Ave., Seattle, WA 98104, USA

4 Department of Biostatistics. University of Washington, Box 357232, 1959 NE Pacific Street, Seattle, Washington, 98195, USA

5 Department of Psychiatry and Behavioral Sciences. University of Washington, Box 356560, 1959 NE Pacific Street, Seattle, Washington, 98195 USA

6 Center for Cost and Outcomes Research. Box 359736, 325 Ninth Ave. Seattle, Washington, 98104, USA

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BMC Musculoskeletal Disorders 2005, 6:24  doi:10.1186/1471-2474-6-24

Published: 24 May 2005

Abstract

Background

The diagnosis of discogenic back pain often leads to spinal fusion surgery and may partly explain the recent rapid increase in lumbar fusion operations in the United States. Little is known about how patients undergoing lumbar fusion compare in preoperative physical and psychological function to patients who have degenerative discs, but receive only non-surgical care.

Methods

Our group is implementing a multi-center prospective cohort study to compare patients with presumed discogenic pain who undergo lumbar fusion with those who have non-surgical care. We identify patients with predominant low back pain lasting at least six months, one or two-level disc degeneration confirmed by imaging, and a normal neurological exam. Patients are classified as surgical or non-surgical based on the treatment they receive during the six months following study enrollment.

Results

Three hundred patients discogenic low back pain will be followed in a prospective cohort study for two years. The primary outcome measure is the Modified Roland-Morris Disability Questionnaire at 24-months. We also evaluate several other dimensions of outcome, including pain, functional status, psychological distress, general well-being, and role disability.

Conclusion

The primary aim of this prospective cohort study is to better define the outcomes of lumbar fusion for discogenic back pain as it is practiced in the United States. We additionally aim to identify characteristics that result in better patient selection for surgery. Potential predictors include demographics, work and disability compensation status, initial symptom severity and duration, imaging results, functional status, and psychological distress.