Back Pain: Wang J

Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, Mummaneni P, Watters WC, Wang J, Walters BC, Hadley MN, Anonymous00068. · Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA. · J Neurosurg Spine. · Pubmed #16028742 No free full text.

Abstract: Although conflicting reports have been presented in the literature regarding the utility of lumbar braces for the prevention of low-back pain, most Class III medical evidence suggests that these supports used prophylactically do not reduce the incidence of low-back pain or decrease the amount of time lost from work in the general working population. Among workers with a history of a back injury, their use appears to decrease the number of work days lost due to back pain. Lumbar braces appear to be an effective treatment for acute low-back pain in some populations. They do not appear to be effective in the chronic low-back pain population. If a brace is used, rigid braces offer some benefit over soft braces. There are no data to suggest that relief of low-back pain with preoperative external bracing predicts a favorable outcome following lumbar spinal fusion. No information is available on the benefit of bracing for improving fusion rates or clinical outcomes following instrumented lumbar fusion for degenerative disease.

Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, Mummaneni P, Watters WC, Wang J, Walters BC, Hadley MN, Anonymous00067. · Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA. · J Neurosurg Spine. · Pubmed #16028741 No free full text.

Abstract: In summary, there is no meaningful evidence in the medical literature that the use of epidural injections is of any long-term value in the treatment of patients with chronic low-back pain. The literature does indicate that the use of lumbar epidural injections can provide short-term relief in selected patients with chronic low-back pain. There is evidence that suggests that facet joint injections can be used to predict outcome after RF ablation of a facet joint. The predictive ability of facet joint injections does not appear to apply to lumbar fusion surgery. No evidence exists to support the effectiveness of facet injections in the treatment of patients with chronic low-back pain. There is conflicting evidence suggesting that the use of local TPIs can be effective for the short-term relief of low-back pain. There are no data to suggest that TPIs with either steroids or anesthetics alone provide lasting benefit for patients suffering from chronic low-back pain.

Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, Mummaneni P, Watters WC, Wang J, Walters BC, Hadley MN, Anonymous00066. · Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA. · J Neurosurg Spine. · Pubmed #16028740 No free full text.

Abstract: This review focused on an examination of the literature on the surgical treatment of low-back pain in patients with DDD or low-grade degenerative spondylolisthesis treated with PLF, with or without the use of pedicle screw fixation. All Class I and the majority of Class II and Class III medical evidence on this topic indicates that the addition of pedicle screw fixation to PLF increases fusion success rates when assessed based on plain x-ray films with dynamic imaging. Although there does appear to be a positive relationship between radiographic fusion and clinical outcome, no convincing correlation has been demonstrated. Although several reports suggest that clinical outcomes are improved with the addition of pedicle screw fixation, there are conflicting findings from similarly classified evidence sources (primarily Class II and III). Furthermore, the largest contemporary randomized controlled study on this topic failed to demonstrate a significant beneficial effect for the use of pedicle screw fixation in patients treated with PLF for chronic low-back pain. This absence of proof should not, however, be interpreted as a proof of absence. For example, in this same study, patient satisfaction scores improved from approximately 60% to approximately 70% with the addition of pedicle screw fixation. This difference in outcome may be clinically relevant. Similarly, the improvement in ODI scores was 40% greater in the group of patients treated with pedicle screw fixation compared with those treated with PLF alone. If an analysis to determine the sample size necessary to ensure a power of 0.8 (or an 80% chance of detecting a significant effect) in a study in which the good outcome rate is 60% in the control group and 70% in the treatment group is performed, approximately 355 patients would be needed in each treatment group (http://department.obg.cuhk.edu.hk). Alternatively, if a similar analysis is performed using the differential scores obtained in the ODI measurements reported in the paper by Fritzell, et al., approximately 225 patients would be needed per treatment group (http://calculators.stat.ucla.edu/powercalc). Although Fritzell, et al., did not detect a significant benefit associated with the use of pedicle screw fixation as an adjunct to PLF, their sample size severely limited the power of their study to detect such a benefit. All studies reviewed suffer from similar lack of power. Therefore, no definitive statement regarding the efficacy of pedicle screw fixation as a means to improve functional outcomes in patients undergoing PLF for chronic low-back pain can be made. There appears to be consistent evidence suggesting that pedicle screw fixation increases the costs and complication rate of PLF. It is recommended, therefore, that the use of pedicle screw fixation as a supplement to PLF be reserved for those patients in whom there is an increased risk of nonunion when treated with PLF. High-risk patients include, but are not limited to patients who smoke, who are undergoing revision surgery, or who suffer systemic diseases known to be associated with poor bone healing.

Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, Mummaneni P, Watters WC, Wang J, Walters BC, Hadley MN, Anonymous00065. · Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA. · J Neurosurg Spine. · Pubmed #16028739 No free full text.

Abstract: The majority of reviewed medical evidence suggests that interbody techniques are associated with higher fusion rates compared with PLF when applied to patients with low-back pain due to DDD limited to one or two levels. The evidence is generally of poor quality and retrospective in nature. Conflicting evidence exists supporting the role of interbody graft placement for improvement of functional outcomes; however, there is no Class I or II evidence to suggest that the use of an interbody graft is associated with worse outcomes, and Class II evidence exists to suggest that outcomes are improved. Complication rates of interbody graft placement, particularly of circumferential procedures, are higher in most series. Many complications, however, are associated with pedicle screw fixation and not with interbody graft placement per se. In the context of a single-level stand-alone ALIF or ALIF with posterior instrumentation, there does not appear to be a substantial benefit to the addition of a PLF. The addition of a PLF to a construct that already includes an interbody graft is, however, associated with increased costs and complications. Therefore, although the addition of supplemental fixation (a 270 degrees fusion) may be necessary for biomechanical reasons, it may not be appropriate to subject the patient to the morbidity of a full posterior exposure for placement of graft material. Significant differences in clinical outcomes between the various interbody techniques have not been convincingly demonstrated. No general recommendation can therefore be made regarding the technique that should be used to achieve interbody fusion.

Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, Mummaneni P, Watters WC, Wang J, Walters BC, Hadley MN, Anonymous00062. · Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA. · J Neurosurg Spine. · Pubmed #16028736 No free full text.

Abstract: There is no convincing medical evidence to support the routine use of lumbar fusion at the time of a primary lumbar disc excision. There is conflicting Class III medical evidence regarding the potential benefit of the addition of fusion in this circumstance. Therefore, the definite increase in cost and complications associated with the use of fusion are not justified. Patients with preoperative lumbar instability may benefit from fusion at the time of lumbar discectomy; however, the incidence of such instability appears to be very low (< 5%) in the general lumbar disc herniation population. Patients who suffer from chronic low-back pain, or are heavy laborers or athletes with axial low-back pain, in addition to radicular symptoms may also be candidates for fusion at the time of lumbar disc excision. Patients with a recurrent disc herniation have been treated successfully with both reoperative discectomy and reoperative discectomy combined with fusion. In patients with a recurrent lumbar disc herniation with associated spinal deformity, instability, or associated chronic low-back pain, consideration of fusion in addition to reoperative discectomy is recommended.

Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, Mummaneni P, Watters WC, Wang J, Walters BC, Hadley MN, Anonymous00061. · Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA. · J Neurosurg Spine. · Pubmed #16028735 No free full text.

Abstract: Class I medical evidence exists in support of the use of lumbar fusion as a treatment standard for carefully selected patients with low-back pain intractable to the best medical management. There is Class III medical evidence that suggests that a course of intensive cognitive and physical therapy may be an efficacious treatment option for the treatment of patients with chronic disabling low-back pain.

Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, Mummaneni P, Watters WC, Wang J, Walters BC, Hadley MN, Anonymous00060. · Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA. · J Neurosurg Spine. · Pubmed #16028734 No free full text.

Abstract: Discography is an exquisitely sensitive but not specific diagnostic test for the diagnosis of discogenic low-back pain. The restriction of the definition of a positive discographic study to one that elicits concordant pain from a morphologically abnormal disc improves the definition's accuracy. Fusion surgery based on discography alone, however, is not reliably associated with clinical success. Therefore, discography is not recommended as a standalone test for treatment decisions in patients with low-back pain. Magnetic resonance imaging is a sensitive and noninvasive test for the presence of degenerative disc disease. Discography should not be attempted in patients with normal lumbar MR images. Discography appears to have a role in the evaluation of patients with low-back pain, but it is best limited to the evaluation of abnormal interspaces identified on MR imaging, the investigation of adjacent-level disc disease, and as a means to rule out cases of nonorganic pain from surgical consideration.

Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, Mummaneni P, Watters WC, Wang J, Walters BC, Hadley MN, Anonymous00056. · Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA. · J Neurosurg Spine. · Pubmed #16028730 No free full text.

Abstract: Functional disability secondary to acute low-back pain, chronic low-back pain, lumbar stenosis, and lumbar disc disease may be reliably and validly assessed using functional outcome surveys that are valid, reliable, and responsive. Outcome instruments supported by Class I and Class II medical evidence for the evaluation of low-back pain include the Spinal Stenosis Survey of Stucki, Waddell-Main, RMDQ, DPQ, QPDS, SIP, Million Scale, LBPR Scale, ODI, and CBSQ. Many of these outcome measures have been applied to patients who have been treated with lumbar fusion for degenerative lumbar disease and have proven to be valid and responsive; however, the reliability of these instruments has never been specifically assessed in the lumbar fusion patient population. Patient satisfaction surveys have been used to measure outcome following lumbar fusion. Their usefulness resides in their insight into patient attitudes toward the treatment experience but is limited because of their inability to measure responsiveness and the lack of information on their reliability.

Wang J, Zhou Y, Li C, Zhang Z, Zhang N. · Department of Orthopaedics, Xinqiao Hospital, Third Military Medical University, Chongqing, PR China. · Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. · Pubmed #19431973 No free full text.

Abstract: OBJECTIVE: To evaluate the preliminary clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) for patient with discogenic chronic low back pain (CLBP) and failing to respond to conservative treatment. METHODS: From June 2007 to May 2008, 52 patients with CLBP and failing to respond to conservative treatment were treated, including 15 males and 37 females aged 29-46 years old (average 38.2 years old). Those patients were diagnosed with discogenic pain by low pressure discography. Duration of CLBP was 6-110 months with an average of 32.1 months. MRI exam revealed 108 "black intervertebral discs" low in signal on T2 image, including 3 discs of L2,3, 17 of L3,4, 48 of L4,5 and 40 of L5-S1. Pressure-controlled discography showed positive response, fluoroscopy or intraoperative CT confirmed annulus fibrosus tears of posterior intervertebral disc in 79 discs. PELD was performed. Visual analogue scale (VAS) was evaluated before operation, 1 month after operation and at the final follow-up. The clinical outcome was determined by modified Macnab criteria at the final follow-up. RESULTS: The average operation time of each disc was 30.7 minutes (range 21-36 minutes), and the mean length of postoperative hospital stay was 3.7 days (range 2-5 days). No complications such as infection and the injury of blood vessels and nerves occurred. Transient paralysis of nerve occurred in 5 cases on operation day, and those symptoms were disappeared at the final follow-up visit without special treatment. Fifty-two cases were followed up for 3-15 months (average 7.3 months). VAS score before operation, 1 month after operation and at the final follow-up was (7.34 +/- 1.52), (3.62 +/- 0.92) and (1.57 +/- 0.48) points, respectively, indicating there were significant differences compared with preoperative score (P < 0.01). According to the modified Macnab criteria, 11 cases were graded as excellent, 23 as good, 13 as fair, 5 as bad, and the excellent and good rate was 65.38%. CONCLUSION: Preliminary study suggests that PELD is safe and effective in treating patient with discogenic CLBP and failing to respond to conservative treatment.

Zhou Y, Wang J, Chu TW, Li CQ, Zhang ZF, Wang WD, Pan Y. · Department of Orthopaedics, Xinqiao Hospital, the Third Military Medical University, Chongqing 400037, China. · Zhonghua Wai Ke Za Zhi. · Pubmed #19094625 No free full text.

Abstract: OBJECTIVE: To evaluate the results of micro-endoscopic revision surgery for recurrent disc herniation, and compare the results of disc excision with and without interbody fusion. METHODS: A total of 32 patients included who had undergone micro-endoscopic revision discectomy for recurrent disc herniation with or without interbody fusion has been surveyed to assess their clinical outcome. The 27 patients who had been followed were divided into two groups; the micro-endoscopic discectomy alone 14 cases, the micro-endoscopic discectomy with interbody fusion 13 cases. With an average follow-up of 25.5 months. Clinical symptoms were assessed based on the VAS scores and Nakai criteria. All medical and surgical records were examined and analyzed, including intraoperative blood loss, length of surgery, and postsurgery hospital stay et al. RESULTS: The statistical difference in the postoperative back pain and leg pain score compared with preoperative score were significant (P < 0.05) or very significant (P < 0.01). Clinical outcomes were excellent or good in 92.8% of patients undergoing a micro-endoscopic discectomy alone, and in 85.5% of patients with interbody fusion. The statistical difference between the fusion and non-fusion groups was insignificant (P = 0.793). But the two groups intraoperative blood loss, length of surgery, length of hospitalization and expenses were significantly less in patients undergoing discectomy alone than in patients with interbody fusion. CONCLUSIONS: Micro-endoscopic revision surgery for recurrent disc herniation is very effective and safety. Micro-endoscopic discectomy alone is first choice for managing recurrent disc herniation.

Liu J, Wang J. · Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, P.R. China. · Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. · Pubmed #18575436 No free full text.

Abstract: OBJECTIVE: To investigate clinical outcomes of percutaneous kyphoplasty with balloon in the treatment of severe osteoporotic thoracic vertebral compression fracture (SVCF). METHODS: From May 2006 to July 2007, percutaneous unilateral kyphoplasty with single balloon was performed in 7 vertebras of 6 SVCF patients, with 2 injured vertebras in 2 males and 5 in 4 females, who were from 64 to 83 years old. The injured vertebras included 1 in T5, 2 in T8, 3 in T10 and 1 in T12 and the compression rates were 60% to 75% in 5 vertebras and > 75% in 2 vertebras. All the injured vertebras were old fractures and caused severe back pain, but without any neurotic symptoms and signs. The visual analogue scale (VAS) ranged from 6.5 to 9.0, 7.7 on average. The posterior vertebral walls were all intact in all patients under CT scan. The balloon was inset into the vertebra through pedicle of vertebral arch by percutaneous puncture under the guidance of C-type arm X-ray unit. The balloon was then extended to restore the vertebral body which was filled with bone cement later. The average volume of cement required was 3.5 mL (2.6 to 4.4 mL). RESULTS: The pain was alleviated or completely relieved after the operation. The mean vertebral body height restoration was 9.7% +/- 1.4% on the anterior border. Two cement leakages were found on X-ray. One month after the treatment, the VAS was from 0 to 2.45, 1.32 on average, and there was significant difference compared with preoperation (P < 0.05). Three months after the treatment, the VAS was from 0 to 3, 2.13 on average, and there was no significant difference compared with 1 month after the treatment (P > 0.05). It was not found that the injured vertebras were compressed or deformed, and no new compressed fracture was found in consecutive vertebras. CONCLUSION: Unilateral posterior-lateral puncture kyphoplasty with single balloon can relieve the pain and restore part of the vertebral height effectively with better outcomes.

Patten SB, Williams JV, Wang J. · Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada. · BMC Musculoskelet Disord. · Pubmed #16638139 links to  free full text

Abstract: BACKGROUND: Studies using clinical and volunteer samples have reported an elevated prevalence of mood disorders in association with rheumatoid arthritis and osteoarthritis. Clinical studies using anxiety rating scales have reported inconsistent results, but studies using diagnostic instruments have reported that anxiety disorders may be even more strongly associated with arthritis than is depression. One study reported an association between lifetime substance use disorders and arthritis. METHODS: Data from iteration 1.2 of the Canadian Community Health Survey (CCHS) were used. This was a large-scale national Canadian health survey which administered the World Mental Health Composite International Diagnostic Interview to a sample of 36,984 subjects randomly selected from the national population. In the CCHS 1.2, subjects were asked whether they had been diagnosed by a health professional with arthritis or rheumatism. RESULTS: Subjects reporting arthritis or rheumatism had an elevated prevalence of mood, anxiety and substance use disorders. The strength of association resembled that seen in an omnibus category reporting any chronic condition, but was weaker than that seen with back pain or fibromyalgia. The effect of arthritis or rheumatism interacted with age, such that the odds ratios became smaller with increasing age. Mood and anxiety disorders, along with arthritis or rheumatism made an independent contribution to disability. CONCLUSION: Arthritis is associated with psychiatric morbidity in the general population, and this morbidity is seen across a variety of mental disorders. The strength of association is consistent with that seen in persons with other self-reported medical conditions.

Zhou Y, Wang J, Chu TW, Wang WD, Zheng WJ, Hao Y, Pan Y, Teng HJ. · Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China. · Zhonghua Wai Ke Za Zhi. · Pubmed #16271244 No free full text.

Abstract: OBJECTIVE: To discuss the surgical technique, indication and the clinical effects of the Microscope Endoscopic Tubular Retractor System (METRx) for microendoscopic lumbar diskectomy with the preservation of the ligamentum flavum. METHODS: Two hundred and eleven patients underwent single-segment METRx, with ligamentum flavum preservation in 65 patients (Group A), and without preservation in 146 patients (Group B). The two groups were compared clinically. All the patients suffered from low back pain and radicular syndrome to some extent, and the diagnosis was affirmed by CT and/or MRI. After exposed the interlaminar space regularly, the superior, inferior and lateral edge of the ligamentum flavum was released, the 3-sided dissociative ligament pacth was retracted medially during the spinal manipulation and restored anatomically after disc removal and the decompression of the nerve root. RESULTS: According to the results of two groups, ligamentum flavum preservation technique was feasible under endoscope and helpful in reducing the scar formation in the spinal canal. CONCLUSIONS: The ligamentum flavum preservation technique enable the surgeons to preserve the natural barrier. It is feasible to perform METRx, and it is helpful in reducing the epidural fibrosis.

Currie SR, Wang J. · Addiction Centre, Foothills Medical Centre, Calgary, CanadaUniversity of Calgary, Canada. · Psychol Med. · Pubmed #16168150 No free full text.

Abstract: BACKGROUND: Few epidemiological studies have examined the temporal relationship between chronic pain and depression using longitudinal data. In the present study, we examined major depression as both an antecedent risk factor and consequence of chronic back pain (CBP) in the general population. METHOD: Data on 9909 pain-free individuals 15 years and older with no history of back problems were drawn from cycle 1 of the National Population Health Survey and followed up 24 months later. Major depression was assessed using a structured diagnostic interview. RESULTS: At cycle 2, the rate of new cases of CBP in persons who were depressed at cycle 1 was 3.6% compared to 1.1% in non-depressed persons. Compared to pain-free individuals, new cases of CBP were more likely to perceive their health status as poor or fair at cycle 1, were less likely to be working, reported more chronic health problems, and sustained a back or neck injury in the preceding 12 months. After controlling for other factors, pain-free individuals diagnosed as major depressed at cycle 1 were almost three times more likely (OR 2.9, 95% CI 1.2-7.0) to develop CBP at cycle 2. CONCLUSIONS: Consistent with other longitudinal studies major depression increases the risk of developing future chronic pain. The causal mechanism linking these conditions is unknown however depression may represent a modifiable risk factor in the development of CBP.

Wang J. · Hospital of TCM, Fufeng County, Shanxi 722200, China. · J Tradit Chin Med. · Pubmed #15688699 No free full text.

This publication has no abstract.

Currie SR, Wang J. · Addiction Centre, Foothills Medical Centre, 1403-29th St. NW, Calgary, Alberta, Canada T2N 2T9. · Pain. · Pubmed #14715389 No free full text.

Abstract: Chronic pain and depression are two of the most common health problems that health professionals encounter, yet only a handful of epidemiological studies have investigated the relationship between these conditions in the general population. In the present study we examined the prevalence and correlates of major depression in persons with chronic back pain using data from the first cycle of Canadian Community Health Survey in a sample of 118,533 household residents. The prevalence of chronic back pain was estimated at 9% of persons 12 years and older. Rates of major depression, determined by the short-form of the Composite International Diagnostic Interview, were estimated at 5.9% for pain-free individuals and 19.8% for persons with chronic back pain. The rate of major depression increased in a linear fashion with greater pain severity. In logistic regression models, back pain emerged as the strongest predictor of major depression after adjusting for possible confounding factors such as demographics and medical co-morbidity. The combination of chronic back pain and major depression was associated with greater disability than either condition alone, although pain severity was found to be the strongest overall predictor of disability.

Guo L, Chen X, Ma Y, Wang J. · Orthopeadic Department, the 309th Hospital of People's Liberation Army, Beijing 100091, China. · Zhonghua Yi Xue Za Zhi. · Pubmed #12425824 No free full text.

Abstract: OBJECTIVE: To evaluate the surgical outcomes of spinal tuberculosis treated with transpedicular instrumentation and interbody auto-grafting. METHODS: Thirty-four patients of thoracolumbar tuberculosis were treated with transpedicular instrumentation, radical focus resection and interbody auto-grafting, combined with 6- or 9-month antituberculous medication from October 1996 to November 1998. All patients were followed-up prospectively for 3 to 5 years postoperatively. RESULTS: The back pain and tuberculous symptoms were relieved about one week postoperatively. The erythrocyte sedimentation rate came back to normal level from 4 to 6 weeks postoperatively. The solid interbody arthodesis was achieved from 4 to 6 months postoperatively. All patients were cured of tuberculous lesions in spinal column or in other region, and there were no tuberculous recurrence. In 12 patients, average preoperative kyphosis angle was 24 degrees (range 10 degrees approximately 32 degrees ), and that was 9 degrees (range 5 degrees approximately 13 degrees ) immediately after surgery. The average correction of kyphotic deformity was 15 degrees and was maintained unchanged in follow-up period postoperatively. Nine patients who had type-C or type-D neurological lesions, according to Frankel gradation, had complete recovery one year postoperatively. CONCLUSION: In spinal tuberculous operation, transpedicular instrumentation and interbody fusion are essential in providing rigid stabilization of spinal column, correcting or preventing kyphotic deformity, accelerating focus healing up and shortening chemotherapy period. Transpedicular instrumentation is necessary in short segments fixation and preserving functional unit of spine.

Rosenman KD, Gardiner JC, Wang J, Biddle J, Hogan A, Reilly MJ, Roberts K, Welch E. · Department of Medicine, Michigan State University, East Lansing 48824-1316, USA. · J Occup Environ Med. · Pubmed #10652685 No free full text.

Abstract: Despite the availability of no fault insurance for wage replacement and medical care costs, the majority of workers diagnosed with an occupational disease do not apply for workers' compensation. The objective of the study was to determine the reasons why workers diagnosed with work-related musculoskeletal disease did not apply for workers' compensation benefits. A cross-sectional study of 1598 individuals diagnosed with neck, upper extremity, and low back work-related musculoskeletal disease from April to June 1996 was performed. All individuals were interviewed over the telephone using a standardized questionnaire. The questionnaire included questions about the precipitating event; demographics; health limitations; mood; pain level; and attitudes toward their health care provider, fellow workers, management, work environment, and filing for workers' compensation. Whenever possible, standardized questions from previous surveys were used. The interviewed individuals with work-related musculoskeletal disease were reported by health care practitioners as required by the state of Michigan's occupational disease reporting law. Workers reported during 12 weeks in the spring of 1996 by a Michigan health care professional as having a neck, back, or upper extremity musculoskeletal disorder were eligible to participate. Among the 2703 reports received, 490 individuals could not be reached, 22 did not speak English, 12 had died or were too incapacitated by other medical conditions, and 581 refused. We interviewed 59% of all eligible workers and 73% of all workers who were reachable and capable of responding in English. Only 25% of workers diagnosed with musculoskeletal disease filed a workers' compensation claim. The factors significantly associated with filing a claim were (1) increased length of employment (> 21 years: odds ratio [OR], 3.01, 95% confidence interval [CI], 1.31 to 6.90); 11 to 20 years: OR, 2.34, 95% CI, 1.01 to 5.47; 6 to 10 years: OR, 1.76, 95% CI, 0.73 to 4.25; 1 to 5 years: OR, 2.36, 95% CI, 1.03 to 5.42; < 1 year: OR, 1.00; (2) lower annual income (< $40,000: OR, 1.75, 95% CI, 1.06 to 2.88 vs > or = $80,000: OR, 1.00); (3) workers' dissatisfaction with coworkers (OR, 1.76, 95% CI, 1.01 to 3.06); (4) physician restrictions on activity (OR, 2.16, 95% CI, 1.55 to 3.00); (5) type of physician providing treatment (specialist, including surgeon or orthopedist: OR, 3.63, 95% CI, 2.37 to 5.55); physical and occupational therapist: OR, 2.15, 95% CI, 1.35 to 3.43); family practitioner: OR, 1.33, 95% CI = 0.89 to 2.01; company physician: OR = 1.00); (6) off work > or = 7 days (OR, 14.85, 95% CI, 10.57 to 20.85); (7) decreased current health status (OR, 0.82, 95% CI, 0.70 to 0.96); and (8) increased severity of illness (OR, 1.24, 95% CI, 1.06 to 20.88). This study showed that only 25% of workers with a work-related musculoskeletal condition filed for workers' compensation and refutes the common perception that an individual with a work-related problem is likely to file a workers' compensation claim. The strongest predictors of who would file were those factors associated with the severity of the condition. Other factors were increasing length of employment, lower annual income, and worker dissatisfaction with coworkers. Our study population consisted mainly of unionized autoworkers, and our findings may not be generalizable to the total workforce.