Discogenic pain is low back pain attributed to mechanical and chemical disruption of an intervertebral disc. When this diagnosis is made, it often leads to lumbar spine fusion, and this form of invasive treatment is rapidly increasing in the United States. However, the diagnosis itself remains controversial, as do diagnostic criteria. The efficacy of various treatment options has not been established in controlled trials. Our goal is to better define the outcomes of lumbar fusion for discogenic back pain and compare them to the outcomes of non-surgical care for patients with clinically similar disc degeneration. In addition, we seek to identify baseline characteristics that distinguish patients who choose surgery from those who do not; determine the frequency and consequences of common complications of spinal fusion; identify patient characteristics that may predict a good response to surgical therapy but not to others; and examine the characteristics and outcomes of patients who undergo repeat back surgery for this condition. This will be a prospective cohort study, because we do not believe a randomized trial for this condition is feasible at this time. Patients with chronic back pain, one- or two-level disc degeneration, and normal neurologic examination will be recruited at three Hospitals in the University of Washington system. Consenting eligible subjects will provide baseline measures of symptoms, physical function, psychological distress, and work status, Treatment decisions will not be dictated by the study, but will be those naturally occurring based on patient and physician preferences. The treatment selected, relevant treatment details, and complications will be recorded for all patients. Follow-up will be obtained at 6 months, one year and two years following initial enrollment, and we will repeat measures of symptoms, physical function, psychological distress, work status, and health care utilization. Accumulating data will be stored in a central database maintained by the core methodology team. The analysis will use appropriate univariate and multivariate techniques to address the study questions, and complication rates will be determined by a uniform prospective data collection process. This study will provide new data on the relative benefits and risks of fusion surgery and non-surgical care for discogenic pain, and help to identify patient characteristics for optimal selection of treatment modalities.
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