NIAMS Muiltidisciplinary Clinical Research Center in...

描述(由申请人提供)： 华盛顿大学提出一项多学科临床研究 致力于研究脊柱和上肢疾病的中心。这些 疾病，特别是下腰痛和腕管综合征，是 在劳动年龄人口中最常见和最致残的疾病。本中心 将包括来自医学、放射科、 骨科和运动医学、神经外科、康复 医学院医学、精神病学和行为科学；以及 公共学院的生物统计和卫生服务系 健康。方法核心将为每个项目提供关键支持： 协助选择议定书细节和执行成果措施， 中央数据积累、数据质量监控、分析策略、 统计分析、结果呈报建议和教育 研究人员对研究架构和统计技术的了解。 拟议的项目解决了与以下方面有关的主要争议和不确定性 脊椎疾患和上肢不适。这些措施包括： 1.腕管综合征。诊断和治疗策略：这 纳入了一项随机试验来评估早期手术的疗效 但有文献记载的腕管综合征，并将决定新的 磁共振神经成像技术(MRNI)准确识别患者 最有可能从早期手术中受益。 2.椎间盘源性腰痛治疗的队列研究：前瞻性队列 研究将比较接受腰椎关节融合术的患者退行性变 间盘性疼痛与那些接受非手术治疗的人有关。我们试图找出 基线特征和结果方面的任何差异，以及 确定可预测任一手术的独特成功的特征 或非手术治疗。 3.腰椎手术的流行病学：比率和趋势：这项分析 国家调查数据、州立医院出院登记和医疗保险索赔 将更新美国各种形式的背部手术的比率；研究可能的 椎间融合器的引入提高了脊柱融合率； 量化脊柱手术向非卧床环境的转变；并确定 再手术率随着时间的推移而上升，正如前面一些人所说的那样 分析。 4.颈椎CT和MR图像合成的可行性 该项目将评估将CT和MRI扫描的数据结合在一起的可能性 颈椎将为手术计划提供更有用的成像 目的比单独测试更重要。它将需要计算机建模，基于 MR-PET扫描的先例。我们将确定外科医生是否会接受 合成图像替代CT-脊髓造影术用于外科 计划。

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.