[laid up doc]

Harrison -

good points man, i have some additional thoughts:

I'd add that there is no accepted gold standard "workup" for evaluating pts for disc pathology and symptomatology, and there is such a thing as "drift" in indication - basically when something comes out, dr's sometimes offer the new tx, even if not the right one, to the wrong pt, and then the tx is blamed. many ppl think that this led to the demise of IDET.

one of the limitations of "evidence based medicine", or EBM, aka use of any given study to guide your decision making, is that in order for the study to apply to YOUR PATIENT, one has to consider the study design. you must look at the inclusion/exclusion criteria, study population, and various statistical constructs that a researcher may use to warp statistics. this is beyond the ability of many patients, which is really unfortunate. one is left to trust what a given MD tells them, and ALL dr's have SOME sort of bias, based on where they trained, their personality, tolerance of risk, personal experience, their patient demographics, etc etc.

as far as evaluating the "success" of surgery/role of any given disc or surgery -- if one does not properly identify pain generators and exclude non-discogenic sources of pain, ensure that the level that is being operated on is the sole pain generator... basically not do a thorough workup - then a level is picked to "fix" and may not be the right level, not be inclusive enough, or may not even be the source of the pt's symptoms.

another factor i will mention is patient expectation... another topic that is really variable in its assessment in research. one of my docs went into a lot of detail as far as what i should expect as a "good" outcome, should i decide to have surgery. others didn't, but i'm glad the one did. different studies define outcomes differently, and as i mentioned before, surgeons have different opinions of different studies, so there you go w/ another confounder.

ok i have rambled enough for one night... i have been meaning to write a post about evaluating literature, so there's a start. i'll start a new thread about research methodology somewhere and repost most of this posting.