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Spine Journal Club: Lumbar Disc Herniation

Led by Carter Cassidy, MD

Papers:

  1. Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long-term outcomes of surgical
    and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10
    year results from the maine lumbar spine study. Spine (Phila Pa 1976). 2005 Apr
    15;30(8):927-35. PubMed PMID: 15834338.
  2. Weber H. Lumbar disc herniation. A controlled, prospective study with ten
    years of observation. Spine (Phila Pa 1976). 1983 Mar;8(2):131-40. PubMed PMID:
    6857385.
  3. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Hanscom B, Skinner JS, Abdu
    WA, Hilibrand AS, Boden SD, Deyo RA. Surgical vs nonoperative treatment for
    lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a
    randomized trial. JAMA. 2006 Nov 22;296(20):2441-50. PubMed PMID: 17119140;
    PubMed Central PMCID: PMC2553805.

 

  1. Contrast statistical methods of these papers.
    1. Outcome measures used
    2. Where is crossover highest? Why?
    3. Methods of randomization
  2. Methods of Treatment for HNP
    1. Weber (83)
    2. Maine
    3. SPORT
  3. Compare/ Contrast results of operation on HNP
    1. Is surgery beneficial in Weber? Maine LSS? SPORT?
    2. Was the study well designed to identify a true difference in treatment?
  4. Weber
    1. How did motor fxn improve depending on surgery vs conservative?
    2. Sensory fxn?
    3. Relapse rate surgery v conservative?
    4. How does length of f/u affect prognostic factors?
  5. MLSS
    1. Review these outcome measures
      1. Roland Disability Questionairre
      2. SF-36
      3. Oswestry Disability Index
    2. What was 10yr f/u rate? Is that acceptable?
    3. In what measures was surgery superior to non op at 10 yrs?
  6. SPORT LDH—Randomized Group
    1. How significant was nonadherence to assignment? What were the significant characteristics in those crossing over?
    2. Were good outcome measures selected?
    3. How were the crossover patients analyzed?
    4. In which analysis did surgery show the most benefit -intent-to-treat or as- treated? Is this what you would expect? Why?

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