Low back pain and sciatica are a complex clinical problem which causes great suffering, disability, and expense. The two constitute the greatest single clinical volume for both neurosurgery and orthopedics. Intradiscal therapy has recently been added to surgery and conservative care for management. Long-term effects of these drugs are not known and definitive criteria to accurately predict success or failure of therapy are not defined. We plan to study a broadly based population of patients to determine the factors associated with success (or failure) of the three major forms of therapy - surgery, intradiscal injection, and conservative care. Data from multiple centers representing neurosurgery and orthopedics will be accumulated on physical and x-ray findings, as well as social, demographic, and psychologic factors in these patients. Outcome will be evaluated for all treatments and correlated with these multivariant factors. Then long-term evaluations will proceed for 5 years to compare the eventual outcomes. Cost of care will be compared. The goal is to appropriately match outcome with treatment.
