This is a multicenter study based upon a stringent protocol and data collection system proven valid over 4 years of use in an existing study. Within this system, 3875 patients have been entered at 7 study centers, 2002 are eligible for and continue in longitudinal follow-up. By the termination date, we project 5000 patients entered and 3000 in follow-up. Of patients currently in follow-up, males and females are equally represented, 88% have a structural abnormality of the spine, and 58.5% have a root compression syndrome. A battery of instruments to obtain demographics, pain severity, prior medical care, physical findings, psychological status, details of diagnostic studies, and mode of treatment has been developed, tested, and used. The longitudinal follow-up, extending at spaced interval from 3 months through 5 years is underway. Detailed analyses of factors related to outcome are now being carried out in the final year of the current study. The overall goal of this competitive renewal is to develop a predictive system that will improve the physician's ability to predict the outcome of treatment options and so optimally to match patients and treatments. To this end, the following aims are proposed:
Aim 1 - To assess longitudinal outcome of treatment of eligible patients in our original cohort of nearly 5000 patients collected during the current study;
Aim 2 - To augment the number of patients in the surgical group to identify more precisely the factors correlated with success and failure;
Aim 3 - To validate the predictive systems by comparing predicted with actual outcome;
Aim 4 - To evaluate both direct and indirect costs of diagnosis and treatment. Analyses of these data should provide a valid predictive system to improve selection of therapy and prediction of outcome.
