Prognostic factors for non-success in patients with sciatica and disc herniation

BMC Musculoskeletal Disorders

Margreth Grotle⁶  Dag Soldal²  Bård Natvig¹  Anne Keller³  Lars Grøvle⁵  Jens Ivar Brox⁴  Anne Julsrud Haugen⁵ 

[1] Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;Department of Rheumatology, Sørlandet Hospital Health Enterprise, Kristiansand, Norway;Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ullevål, Oslo, Norway;Section for Back Surgery and Physical Medicine and Rehabilitation, Orthopaedic Department, Oslo University Hospital, Rikshospitalet, Oslo, Norway;Department of Rheumatology, Østfold Hospital Trust, Fredrikstad, Norway;FORMI (Communication Unit for Musculoskeletal Disorders), Division of Neuroscience, Oslo University Hospital, Ullevål, Oslo, Norway

关键词: Non-success;    Prognostic factors;    Disc herniation;    Sciatica;   

Others  :  1145802
DOI  :  10.1186/1471-2474-13-183

 received in 2012-01-20, accepted in 2012-09-19,  发布年份 2012

【 摘 要 】

Background

Few studies have investigated prognostic factors for patients with sciatica, especially for patients treated without surgery. The aim of this study was to identify factors associated with non-success after 1 and 2 years of follow-up and to test the prognostic value of surgical treatment for sciatica.

Methods

The study was a prospective multicentre observational study including 466 patients with sciatica and lumbar disc herniation. Potential prognostic factors were sociodemographic characteristics, back pain history, kinesiophobia, emotional distress, pain, comorbidity and clinical examination findings. Study participation did not alter treatment considerations for the patients in the clinics. Patients reported on the questionnaires if surgery of the disc herniation had been performed. Uni- and multivariate logistic regression analyses were used to evaluate factors associated with non-success, defined as Maine–Seattle Back Questionnaire score of ≥5 (0–12) (primary outcome) and Sciatica Bothersomeness Index ≥7 (0–24) (secondary outcome).

Results

Rates of non-success were at 1 and 2 years 44% and 39% for the main outcome and 47% and 42% for the secondary outcome. Approximately 1/3 of the patients were treated surgically. For the main outcome variable, in the final multivariate model non-success at 1 year was significantly associated with being male (OR 1.70 [95% CI; 1.06 − 2.73]), smoker (2.06 [1.31 − 3.25]), more back pain (1.0 [1.01 − 1.02]), more comorbid subjective health complaints (1.09 [1.03 − 1.15]), reduced tendon reflex (1.62 [1.03 − 2.56]), and not treated surgically (2.97 [1.75 − 5.04]). Further, factors significantly associated with non-success at 2 years were duration of back problems >; 1 year (1.92 [1.11 − 3.32]), duration of sciatica >; 3 months (2.30 [1.40 − 3.80]), more comorbid subjective health complaints (1.10 [1.03 − 1.17]) and kinesiophobia (1.04 [1.00 − 1.08]). For the secondary outcome variable, in the final multivariate model, more comorbid subjective health complaints, more back pain, muscular weakness at clinical examination, and not treated surgically, were independent prognostic factors for non-success at both 1 and 2 years.

Conclusions

The results indicate that the prognosis for sciatica referred to secondary care is not that good and only slightly better after surgery and that comorbidity should be assessed in patients with sciatica. This calls for a broader assessment of patients with sciatica than the traditional clinical assessment in which mainly the physical symptoms and signs are investigated.

【 授权许可】

   
2012 Haugen et al.; licensee BioMed Central Ltd.

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