NIAMS Muiltidisciplinary Clinical Research Center in...

DESCRIPTION (provided by applicant):
The University of Washington proposes a Multidisciplinary Clinical Research
Center devoted to the study of spine and upper extremity disorders. These
conditions, especially low back pain and carpal tunnel syndrome, are among the
most common and disabling conditions in working age populations. This Center
will incorporate investigators from the Departments of Medicine, Radiology,
Orthopaedics and Sports Medicine, Neurological Surgery, Rehabilitation
Medicine, and Psychiatry and Behavioral Sciences in the School of Medicine; and
the Departments of Biostatistics and Health Services in the School of Public
Health. The Methodology Core will provide key support to each project:
assistance with protocol details choice and implementation of outcome measures,
central data accumulation, data quality monitoring, analytic strategies,
statistical analysis, advice on presentation of results, and education of
investigators regarding research architecture and statistical techniques.
The projects proposed address key controversies and uncertainties related to
spinal disorders and upper extremity complaints. These include:
1. Carpal Tunnel Syndrome. Diagnostic and Treatment Strategies: this
incorporates a randomized trial to evaluate the efficacy of surgery for early
but well-documented carpal tunnel syndrome, and will determine whether the new
technique of MR neurographic imaging (MRNI) accurately identifies the patients
most likely to benefit from early surgery.
2. Cohort Study of Treatment for Discogenic Back Pain: a prospective cohort
study will compare patients undergoing lumbar arthrodesis for degenerative
discogenic pain with those having non-surgical treatments. We seek to identify
any differences in baseline characteristics as well as outcomes, and to
identify characteristics that may predict unique success from either surgical
or non-surgical therapy.
3. Epidemiology of Lumbar Spine Surgery: Rates and Trends: this analysis of
national survey data, state hospital discharge registries, and Medicare claims
will update the U.S. rates of various forms of back surgery; examine a possible
increase in spine fusion rates with the introduction of interbody fusion cages;
quantify the shift of spine surgery to the ambulatory setting; and determine if
reoperation rates are increasing over time, as suggested in some earlier
analyses.
4. Synthesis of CT and MR images of the Cervical Spine: This feasibility
project will assess the potential for combining data from CT and MRI scans of
the cervical spine to produce more useful imaging for surgical planning
purposes than either test alone. It will require computer modeling, based on
precedents in MR-PET scanning. We will determine if surgeons will accept the
synthesized images as a replacement for CT-myelography for purposes of surgical
planning.