Tamara Morgan - Academia.edu (original) (raw)

Papers by Tamara Morgan

PM&R, 2015

To determine risks and predictors of recurrent leg and low back pain (LBP) following unstructured... more To determine risks and predictors of recurrent leg and low back pain (LBP) following unstructured, usual non-operative care for subacute/chronic symptomatic lumbar disc herniation (LDH). Secondary analysis of data from a concurrent randomized trial and observational cohort study. 13outpatientspinepractices. Participants- 199 participants with leg pain resolution and 142 participants with LBP resolution, from among 478 participants receiving usual non-operative care for symptomatic LDH. Potential predictors of recurrence included time to initial symptom resolution, sociodemographics, clinical characteristics, work-related factors, imaging-detected herniation characteristics, and baseline pain bothersomeness. Leg pain and LBP bothersomeness were assessed using a 0 to 6 numerical scale at up to 4 years of follow-up. For individuals with initial resolution of leg pain, we defined recurrent leg pain as having leg pain, receiving lumbar epidural steroid injections, or undergoing lumbar surgery subsequent to initial leg pain resolution. We calculated cumulative risks of recurrence using Kaplan-Meier survival plots, and examined predictors of recurrence using Cox proportional hazards models. We used similar definitions for LBP recurrence. 1- and 3-year cumulative recurrence risks were 23% and 51% for leg pain, and 28% and 70% for LBP, respectively. Early leg pain resolution did not predict future leg pain recurrence. Complete leg pain resolution (adjusted hazard ratio [aHR] 0.47, 95% confidence interval [CI] 0.31-0.72]) and posterolateral herniation location (aHR 0.61 [95% CI 0.39-0.97]) predicted a lower risk of leg pain recurrence, and joint problems (aHR 1.89 [95% CI 1.16-3.05]) and smoking (aHR 1.81 [95% CI 1.07-3.05]) predicted a greater risk of leg pain recurrence. For participants with complete initial resolution of pain, recurrence risks at 1- and 3-years were 16% and 41% for leg pain, and 24% and 59% for LBP, respectively. Recurrence of pain is common after unstructured, usual nonsurgical care for LDH. These risk estimates depend on the specific definitions applied, and the predictors identified require replication in future studies.

JAMA, 2006

Context Lumbar diskectomy is the most common surgical procedure performed for back and leg sympto... more 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.

European Spine Journal, 1996

Unexpected loads, which often occur in the working environment, can lead to high forces in the sp... more Unexpected loads, which often occur in the working environment, can lead to high forces in the spine and, thus, may be a cause of low back injury. This paper discusses the effect of “sudden load” on the erector spine reaction and amplitude. Muscle responses were mediated by several factors, including fatigue, posture, expectation and rehabilitation, in chronic low back pain

Health Affairs, 2004

Although Medicare rates for surgery to treat degenerative diseases of the hip, knee, and spine ar... more Although Medicare rates for surgery to treat degenerative diseases of the hip, knee, and spine are highly variable among hospital referral regions (HRRs), the relative risk for surgery within a region is constant from year to year-a large majority of the variation in surgery in 2000-01 is "explained" by the variation in rates in 1992-93. The within-region constancy in rates for highly variable procedures (the "surgical signature") is illustrated for South Florida HRRs. Involving the patient in choice of treatments (shared decision making) and outcomes research are promising strategies for reducing unwarranted regional variation and local constancy in surgery risk.

The Journal of Bone and Joint Surgery (American), 2009

Background: The management of degenerative spondylolisthesis associated with spinal stenosis rema... more Background: The management of degenerative spondylolisthesis associated with spinal stenosis remains controversial. Surgery is widely used and has recently been shown to be more effective than nonoperative treatment when the results were followed over two years. Questions remain regarding the long-term effects of surgical treatment compared with those of nonoperative treatment.

New England Journal of Medicine, 2007

Annals of Internal Medicine, 2008

The SPORT (Spine Patient Outcomes Research Trial) reported favorable surgery outcomes over 2 year... more The SPORT (Spine Patient Outcomes Research Trial) reported favorable surgery outcomes over 2 years among patients with stenosis with and without degenerative spondylolisthesis, but the economic value of these surgeries is uncertain.

Spine, 2008

Diskectomy candidates with at least 6 weeks of sciatica and confirmatory imaging were enrolled in... more Diskectomy candidates with at least 6 weeks of sciatica and confirmatory imaging were enrolled in a randomized or observational cohort. This study sought to determine: (1) whether diskectomy resulted in greater improvement in back pain than nonoperative treatment, and (2) whether herniation location and morphology affected back pain outcomes. Previous studies have reported that lumbar diskectomy is less successful for relief of back pain than leg pain and patients with central disc herniations or protrusions have worse outcomes. Patients underwent diskectomy or received "usual" nonoperative care. Data from the randomized cohort and observational cohort were combined in an as-treated analysis. Low back pain was recorded on a 0 to 6 point scale, and changes in low back pain were compared between the surgical and nonoperative treatment groups. The effects of herniation location and morphology on back pain outcomes were determined. The combined analysis included 1191 patients with 775 undergoing surgery within 2 years, whereas 416 remained nonoperative. Overall, leg pain improved more than back pain in both treatment groups. Back pain improved in both surgical and nonoperative patients, but surgical patients improved significantly more (treatment effect favoring surgery -0.9 at 3 months, -0.5 at 2 years, P < 0.001). Patients who underwent surgery were more likely to report no back pain than nonoperative patients at each follow-up period (28.0% vs. 12.0% at 3 months, P < 0.001, 25.5% vs. 17.6% at 2 years, P = 0.009). At baseline, central herniations were associated with more severe back pain than more lateral herniations (4.3 vs. 3.9, P = 0.012). Patients with central herniations and protrusionshad a beneficial treatment effect from surgery similar to the overall surgical group. Diskectomy resulted in greater improvement in back pain than nonoperative treatment, and this difference was maintained at 2 years for all herniation locations and morphologies.

International Workshop on Model Checking of Software, 2000

Diskectomy candidates with at least 6 weeks of sciatica and confirmatory imaging were enrolled in... more Diskectomy candidates with at least 6 weeks of sciatica and confirmatory imaging were enrolled in a randomized or observational cohort. This study sought to determine: (1) whether diskectomy resulted in greater improvement in back pain than nonoperative treatment, and (2) whether herniation location and morphology affected back pain outcomes. Previous studies have reported that lumbar diskectomy is less successful for relief of back pain than leg pain and patients with central disc herniations or protrusions have worse outcomes. Patients underwent diskectomy or received "usual" nonoperative care. Data from the randomized cohort and observational cohort were combined in an as-treated analysis. Low back pain was recorded on a 0 to 6 point scale, and changes in low back pain were compared between the surgical and nonoperative treatment groups. The effects of herniation location and morphology on back pain outcomes were determined. The combined analysis included 1191 patients with 775 undergoing surgery within 2 years, whereas 416 remained nonoperative. Overall, leg pain improved more than back pain in both treatment groups. Back pain improved in both surgical and nonoperative patients, but surgical patients improved significantly more (treatment effect favoring surgery -0.9 at 3 months, -0.5 at 2 years, P < 0.001). Patients who underwent surgery were more likely to report no back pain than nonoperative patients at each follow-up period (28.0% vs. 12.0% at 3 months, P < 0.001, 25.5% vs. 17.6% at 2 years, P = 0.009). At baseline, central herniations were associated with more severe back pain than more lateral herniations (4.3 vs. 3.9, P = 0.012). Patients with central herniations and protrusionshad a beneficial treatment effect from surgery similar to the overall surgical group. Diskectomy resulted in greater improvement in back pain than nonoperative treatment, and this difference was maintained at 2 years for all herniation locations and morphologies.

New England Journal of Medicine, 2007

BACKGROUND-Management of degenerative spondylolisthesis with spinal stenosis is controversial. Su... more BACKGROUND-Management of degenerative spondylolisthesis with spinal stenosis is controversial. Surgery is widely used, but its effectiveness in comparison with that of nonsurgical treatment has not been demonstrated in controlled trials.

Spine, 2008

fees for product development and royalties for cervical spine implants and femoral ring allograft... more fees for product development and royalties for cervical spine implants and femoral ring allograft; Dr. Albert reports receiving reimbursement for attending a symposium, fees for speaking, organizing education, and consulting, and funds for research from DePuy Spine; he has also worked as an independent contractor for DePuy Spine, lecturing on spine topics related to surgery with or without instrumental and molecular biology of the disc. He has received royalties and/ or holds patents for instrumentation that he has designed. He manages his conflicts through transparency and by avoiding when possible inclusion of products he's specifically designed and by being generic in his discussions.

The Journal of bone and joint surgery. American volume, Jan 19, 2015

Lumbar discectomy and laminectomy in patients with intervertebral disc herniation (IDH) is common... more Lumbar discectomy and laminectomy in patients with intervertebral disc herniation (IDH) is common, with variable reported reoperation rates. Our study examined which baseline characteristics might be risk factors for reoperation and compared outcomes between patients who underwent reoperation and those who did not. We performed a retrospective subgroup analysis of patients from the IDH arm of the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. We analyzed baseline characteristics and outcomes of patients who underwent reoperation and those who did not with use of data collected from enrollment through eight-years of follow-up after surgery. Follow-up times were measured from the time of surgery, and baseline covariates were updated to the follow-up immediately preceding the time of surgery for outcomes analyses. At eight years, the reoperation rate was 15% (691 no reoperation; 119 reoperation). Sixty-two percent of these patients underwent reopera...

Spine, Jan 15, 2015

Randomized trial with a concurrent observational cohort study. To compare 8-year outcomes of surg... more Randomized trial with a concurrent observational cohort study. To compare 8-year outcomes of surgery with nonoperative care for symptomatic lumbar spinal stenosis. Surgery for spinal stenosis has been shown to be more effective than nonoperative treatment during 4 years, but longer-term data are less clear. Surgical candidates from 13 centers in 11 US states with at least 12 weeks of symptoms and confirmatory imaging were enrolled in a randomized cohort or observational cohort. Treatment was standard, decompressive laminectomy versus standard nonoperative care. Primary outcomes were SF-36 (MOS 36-Item Short-Form Health Survey) Bodily Pain and Physical Function scales and the modified Oswestry Disability Index assessed at 6 weeks, 3 months, 6 months, and yearly up to 8 years. Data were obtained for 55% of participants in the randomized group and 52% of participants in the observational group at the 8-year follow-up. Intent-to-treat analyses showed no differences between randomized co...

Spine, 2008

fees for product development and royalties for cervical spine implants and femoral ring allograft... more fees for product development and royalties for cervical spine implants and femoral ring allograft; Dr. Albert reports receiving reimbursement for attending a symposium, fees for speaking, organizing education, and consulting, and funds for research from DePuy Spine; he has also worked as an independent contractor for DePuy Spine, lecturing on spine topics related to surgery with or without instrumental and molecular biology of the disc. He has received royalties and/ or holds patents for instrumentation that he has designed. He manages his conflicts through transparency and by avoiding when possible inclusion of products he's specifically designed and by being generic in his discussions.

PM&R, 2015

To determine risks and predictors of recurrent leg and low back pain (LBP) following unstructured... more To determine risks and predictors of recurrent leg and low back pain (LBP) following unstructured, usual non-operative care for subacute/chronic symptomatic lumbar disc herniation (LDH). Secondary analysis of data from a concurrent randomized trial and observational cohort study. 13outpatientspinepractices. Participants- 199 participants with leg pain resolution and 142 participants with LBP resolution, from among 478 participants receiving usual non-operative care for symptomatic LDH. Potential predictors of recurrence included time to initial symptom resolution, sociodemographics, clinical characteristics, work-related factors, imaging-detected herniation characteristics, and baseline pain bothersomeness. Leg pain and LBP bothersomeness were assessed using a 0 to 6 numerical scale at up to 4 years of follow-up. For individuals with initial resolution of leg pain, we defined recurrent leg pain as having leg pain, receiving lumbar epidural steroid injections, or undergoing lumbar surgery subsequent to initial leg pain resolution. We calculated cumulative risks of recurrence using Kaplan-Meier survival plots, and examined predictors of recurrence using Cox proportional hazards models. We used similar definitions for LBP recurrence. 1- and 3-year cumulative recurrence risks were 23% and 51% for leg pain, and 28% and 70% for LBP, respectively. Early leg pain resolution did not predict future leg pain recurrence. Complete leg pain resolution (adjusted hazard ratio [aHR] 0.47, 95% confidence interval [CI] 0.31-0.72]) and posterolateral herniation location (aHR 0.61 [95% CI 0.39-0.97]) predicted a lower risk of leg pain recurrence, and joint problems (aHR 1.89 [95% CI 1.16-3.05]) and smoking (aHR 1.81 [95% CI 1.07-3.05]) predicted a greater risk of leg pain recurrence. For participants with complete initial resolution of pain, recurrence risks at 1- and 3-years were 16% and 41% for leg pain, and 24% and 59% for LBP, respectively. Recurrence of pain is common after unstructured, usual nonsurgical care for LDH. These risk estimates depend on the specific definitions applied, and the predictors identified require replication in future studies.

JAMA, 2006

Context Lumbar diskectomy is the most common surgical procedure performed for back and leg sympto... more 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.

European Spine Journal, 1996

Unexpected loads, which often occur in the working environment, can lead to high forces in the sp... more Unexpected loads, which often occur in the working environment, can lead to high forces in the spine and, thus, may be a cause of low back injury. This paper discusses the effect of “sudden load” on the erector spine reaction and amplitude. Muscle responses were mediated by several factors, including fatigue, posture, expectation and rehabilitation, in chronic low back pain

Health Affairs, 2004

Although Medicare rates for surgery to treat degenerative diseases of the hip, knee, and spine ar... more Although Medicare rates for surgery to treat degenerative diseases of the hip, knee, and spine are highly variable among hospital referral regions (HRRs), the relative risk for surgery within a region is constant from year to year-a large majority of the variation in surgery in 2000-01 is "explained" by the variation in rates in 1992-93. The within-region constancy in rates for highly variable procedures (the "surgical signature") is illustrated for South Florida HRRs. Involving the patient in choice of treatments (shared decision making) and outcomes research are promising strategies for reducing unwarranted regional variation and local constancy in surgery risk.

The Journal of Bone and Joint Surgery (American), 2009

Background: The management of degenerative spondylolisthesis associated with spinal stenosis rema... more Background: The management of degenerative spondylolisthesis associated with spinal stenosis remains controversial. Surgery is widely used and has recently been shown to be more effective than nonoperative treatment when the results were followed over two years. Questions remain regarding the long-term effects of surgical treatment compared with those of nonoperative treatment.

New England Journal of Medicine, 2007

Annals of Internal Medicine, 2008

The SPORT (Spine Patient Outcomes Research Trial) reported favorable surgery outcomes over 2 year... more The SPORT (Spine Patient Outcomes Research Trial) reported favorable surgery outcomes over 2 years among patients with stenosis with and without degenerative spondylolisthesis, but the economic value of these surgeries is uncertain.

Spine, 2008

Diskectomy candidates with at least 6 weeks of sciatica and confirmatory imaging were enrolled in... more Diskectomy candidates with at least 6 weeks of sciatica and confirmatory imaging were enrolled in a randomized or observational cohort. This study sought to determine: (1) whether diskectomy resulted in greater improvement in back pain than nonoperative treatment, and (2) whether herniation location and morphology affected back pain outcomes. Previous studies have reported that lumbar diskectomy is less successful for relief of back pain than leg pain and patients with central disc herniations or protrusions have worse outcomes. Patients underwent diskectomy or received "usual" nonoperative care. Data from the randomized cohort and observational cohort were combined in an as-treated analysis. Low back pain was recorded on a 0 to 6 point scale, and changes in low back pain were compared between the surgical and nonoperative treatment groups. The effects of herniation location and morphology on back pain outcomes were determined. The combined analysis included 1191 patients with 775 undergoing surgery within 2 years, whereas 416 remained nonoperative. Overall, leg pain improved more than back pain in both treatment groups. Back pain improved in both surgical and nonoperative patients, but surgical patients improved significantly more (treatment effect favoring surgery -0.9 at 3 months, -0.5 at 2 years, P < 0.001). Patients who underwent surgery were more likely to report no back pain than nonoperative patients at each follow-up period (28.0% vs. 12.0% at 3 months, P < 0.001, 25.5% vs. 17.6% at 2 years, P = 0.009). At baseline, central herniations were associated with more severe back pain than more lateral herniations (4.3 vs. 3.9, P = 0.012). Patients with central herniations and protrusionshad a beneficial treatment effect from surgery similar to the overall surgical group. Diskectomy resulted in greater improvement in back pain than nonoperative treatment, and this difference was maintained at 2 years for all herniation locations and morphologies.

International Workshop on Model Checking of Software, 2000

Diskectomy candidates with at least 6 weeks of sciatica and confirmatory imaging were enrolled in... more Diskectomy candidates with at least 6 weeks of sciatica and confirmatory imaging were enrolled in a randomized or observational cohort. This study sought to determine: (1) whether diskectomy resulted in greater improvement in back pain than nonoperative treatment, and (2) whether herniation location and morphology affected back pain outcomes. Previous studies have reported that lumbar diskectomy is less successful for relief of back pain than leg pain and patients with central disc herniations or protrusions have worse outcomes. Patients underwent diskectomy or received "usual" nonoperative care. Data from the randomized cohort and observational cohort were combined in an as-treated analysis. Low back pain was recorded on a 0 to 6 point scale, and changes in low back pain were compared between the surgical and nonoperative treatment groups. The effects of herniation location and morphology on back pain outcomes were determined. The combined analysis included 1191 patients with 775 undergoing surgery within 2 years, whereas 416 remained nonoperative. Overall, leg pain improved more than back pain in both treatment groups. Back pain improved in both surgical and nonoperative patients, but surgical patients improved significantly more (treatment effect favoring surgery -0.9 at 3 months, -0.5 at 2 years, P < 0.001). Patients who underwent surgery were more likely to report no back pain than nonoperative patients at each follow-up period (28.0% vs. 12.0% at 3 months, P < 0.001, 25.5% vs. 17.6% at 2 years, P = 0.009). At baseline, central herniations were associated with more severe back pain than more lateral herniations (4.3 vs. 3.9, P = 0.012). Patients with central herniations and protrusionshad a beneficial treatment effect from surgery similar to the overall surgical group. Diskectomy resulted in greater improvement in back pain than nonoperative treatment, and this difference was maintained at 2 years for all herniation locations and morphologies.

New England Journal of Medicine, 2007

BACKGROUND-Management of degenerative spondylolisthesis with spinal stenosis is controversial. Su... more BACKGROUND-Management of degenerative spondylolisthesis with spinal stenosis is controversial. Surgery is widely used, but its effectiveness in comparison with that of nonsurgical treatment has not been demonstrated in controlled trials.

Spine, 2008

fees for product development and royalties for cervical spine implants and femoral ring allograft... more fees for product development and royalties for cervical spine implants and femoral ring allograft; Dr. Albert reports receiving reimbursement for attending a symposium, fees for speaking, organizing education, and consulting, and funds for research from DePuy Spine; he has also worked as an independent contractor for DePuy Spine, lecturing on spine topics related to surgery with or without instrumental and molecular biology of the disc. He has received royalties and/ or holds patents for instrumentation that he has designed. He manages his conflicts through transparency and by avoiding when possible inclusion of products he's specifically designed and by being generic in his discussions.

The Journal of bone and joint surgery. American volume, Jan 19, 2015

Lumbar discectomy and laminectomy in patients with intervertebral disc herniation (IDH) is common... more Lumbar discectomy and laminectomy in patients with intervertebral disc herniation (IDH) is common, with variable reported reoperation rates. Our study examined which baseline characteristics might be risk factors for reoperation and compared outcomes between patients who underwent reoperation and those who did not. We performed a retrospective subgroup analysis of patients from the IDH arm of the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. We analyzed baseline characteristics and outcomes of patients who underwent reoperation and those who did not with use of data collected from enrollment through eight-years of follow-up after surgery. Follow-up times were measured from the time of surgery, and baseline covariates were updated to the follow-up immediately preceding the time of surgery for outcomes analyses. At eight years, the reoperation rate was 15% (691 no reoperation; 119 reoperation). Sixty-two percent of these patients underwent reopera...

Spine, Jan 15, 2015

Randomized trial with a concurrent observational cohort study. To compare 8-year outcomes of surg... more Randomized trial with a concurrent observational cohort study. To compare 8-year outcomes of surgery with nonoperative care for symptomatic lumbar spinal stenosis. Surgery for spinal stenosis has been shown to be more effective than nonoperative treatment during 4 years, but longer-term data are less clear. Surgical candidates from 13 centers in 11 US states with at least 12 weeks of symptoms and confirmatory imaging were enrolled in a randomized cohort or observational cohort. Treatment was standard, decompressive laminectomy versus standard nonoperative care. Primary outcomes were SF-36 (MOS 36-Item Short-Form Health Survey) Bodily Pain and Physical Function scales and the modified Oswestry Disability Index assessed at 6 weeks, 3 months, 6 months, and yearly up to 8 years. Data were obtained for 55% of participants in the randomized group and 52% of participants in the observational group at the 8-year follow-up. Intent-to-treat analyses showed no differences between randomized co...

Spine, 2008

fees for product development and royalties for cervical spine implants and femoral ring allograft... more fees for product development and royalties for cervical spine implants and femoral ring allograft; Dr. Albert reports receiving reimbursement for attending a symposium, fees for speaking, organizing education, and consulting, and funds for research from DePuy Spine; he has also worked as an independent contractor for DePuy Spine, lecturing on spine topics related to surgery with or without instrumental and molecular biology of the disc. He has received royalties and/ or holds patents for instrumentation that he has designed. He manages his conflicts through transparency and by avoiding when possible inclusion of products he's specifically designed and by being generic in his discussions.