Richard A Deyo

BACKGROUND: Chronic back pain is an important health problem. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat people with low back pain, especially people with acute back pain. Short term NSAID use is also recommended for pain relief in people with chronic back pain. Two types of NSAIDs are available and used to treat back pain: non-selective NSAIDs and selective COX-2 NSAIDs. In 2008, a Cochrane review identified a small but significant effect from NSAIDs ...

STUDY DESIGN: Population-based cohort study of Washington State patients who underwent lumbar spine surgery for degenerative conditions in 1988.

OBJECTIVES: To compare complications and reoperation rates during the 5-year period after surgery between patients who have undergone lumbar spine fusion surgery and those who have undergone laminectomy or discectomy alone.

SUMMARY OF BACKGROUND DATA: Spinal fusion is associated with wider surgical exposure, more extensive dissection, and longer ...

CONTEXT: For patients with lumbar disk herniation, the Spine Patient Outcomes Research Trial (SPORT) randomized trial intent-to-treat analysis showed small but not statistically significant differences in favor of diskectomy compared with usual care. However, the large numbers of patients who crossed over between assigned groups precluded any conclusions about the comparative effectiveness of operative therapy vs usual care.

OBJECTIVE: To compare the treatment effects of diskectomy and ...

BACKGROUND: Lumbar spinal stenosis is one of the most common causes of low back pain among older adults and can cause significant disability. Despite its prevalence, treatment of spinal stenosis symptoms remains controversial. Epidural steroid injections are used with increasing frequency as a less invasive, potentially safer, and more cost-effective treatment than surgery. However, there is a lack of data to judge the effectiveness and safety of epidural steroid injections for spinal ...

STUDY DESIGN: Retrospective cohort study using a hospital discharge registry of all nonfederal acute care hospitals in Washington state.

OBJECTIVES: To determine the cumulative incidence of reoperation following lumbar surgery for degenerative disease and, for specific diagnoses, to compare the frequency of reoperation following fusion with that following decompression alone.

SUMMARY OF BACKGROUND DATA: Repeat lumbar spine operations are generally undesirable, implying persistent ...

CONTEXT: In recent decades, the fastest growth in lumbar surgery occurred in older patients with spinal stenosis. Trials indicate that for selected patients, decompressive surgery offers an advantage over nonoperative treatment, but surgeons often recommend more invasive fusion procedures. Comorbidity is common in older patients, so benefits and risks must be carefully weighed in the choice of surgical procedure.

OBJECTIVE: To examine trends in use of different types of stenosis ...

BACKGROUND: The U.S. population of former prison inmates is large and growing. The period immediately after release may be challenging for former inmates and may involve substantial health risks. We studied the risk of death among former inmates soon after their release from Washington State prisons.

METHODS: We conducted a retrospective cohort study of all inmates released from the Washington State Department of Corrections from July 1999 through December 2003. Prison records were ...

STUDY DESIGN: A prospective cohort study of patients in Maine with sciatica and lumbar spinal stenosis treated surgically and nonsurgically.

SUMMARY OF BACKGROUND DATA: In 1987, the Quebec Task Force on Spinal Disorders proposed a diagnostic classification to help make clinical decisions, evaluate quality of care, assess prognosis, and conduct research.

OBJECTIVES: To assess the Quebec Task Force classification's ability to stratify patients according to severity and treatment at ...

BACKGROUND: Low-back problems are one of the most frequent reasons for disability compensation claims by workers. However, the effect of Workers' Compensation status on the long-term outcome for workers with sciatica has not been studied in detail, to our knowledge. Therefore, we believe that it is important to describe the long-term outcomes for patients who have herniation of a lumbar disc and sciatica according to the Workers' Compensation status at the time of the preoperative ...

Since the late 1970's, an empirical relationship between the volume of procedures performed by a provider (a hospital or surgeon) and the outcome has been documented for various operations. The present study examines the relationship between the volume of hip replacements performed by surgeons and hospitals and the postoperative rate of complications. A statewide hospital discharge registry was used to identify patients who had had an elective hip replacement between 1988 and 1991. ...

INTRODUCTION: Far fewer opioids are prescribed in Japan than in the United States.

METHODS: We conducted an online physician survey assessing attitudes and perceptions that might influence prescribing. A Japanese version was distributed to members of the Japan Primary Care Association and an English version to members of the American Academy of Family Physicians practicing in Oregon.

RESULTS: We received 461 Japanese responses and 198 from the United States, though overall response rates ...

CONTEXT: Lumbar diskectomy is the most common surgical procedure performed for back and leg symptoms in US patients, but the efficacy of the procedure relative to nonoperative care remains controversial.

OBJECTIVE: To assess the efficacy of surgery for lumbar intervertebral disk herniation.

DESIGN, SETTING, AND PATIENTS: The Spine Patient Outcomes Research Trial, a randomized clinical trial enrolling patients between March 2000 and November 2004 from 13 multidisciplinary spine clinics in ...

STUDY DESIGN: A prospective observational cohort study.

OBJECTIVE: To assess long-term outcomes of patients with lumbar spinal stenosis treated surgically or nonsurgically.

SUMMARY OF BACKGROUND DATA: The relative benefit of various treatments for lumbar spinal stenosis is uncertain. Surgical treatment has been associated with short-term improvement, but recurrence of symptoms has been documented. Few studies have compared long-term outcomes of surgical and nonsurgical ...