The Natural History of Sciatica Associated with Disc Pathology: A Prospective Study with Clinical and Independent Radiologic Follow-Up

Bush, Keith; Cowan, Nigel C.; Katz, David; Gishen, P.

doi:10.1080/1355297x.1993.11719717

Cited by 98 publications

(128 citation statements)

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“…Studies with longer follow-ups suggest that these patients can expect further improvement [1,27]. Patients with neural impingement reported improved pain scores at 6 months, which is likely to reflect the natural regression of disc herniation and sciatic pain known to occur in this group [4].…”

Section: Interpretation Of Resultsmentioning

confidence: 98%

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Self reported health status and magnetic resonance imaging findings in patients with low back pain

Hollingworth

Dixon

Todd

et al. 1998

European Spine Journal

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The authors present a prospective study of quality of life and MRI findings in patients with low back pain (LBP). Disc herniation and nerve root compression contribute to LBP and poor quality of life. However, significant proportions of asymptomatic subjects have disc herniation and neural compromise. Little is known about the influence of disc abnormalities and neural compression on quality of life in symptomatic patients. The purpose of this study was to assess the relationship between the extent of disc abnormality, neural impingement and quality of life. A total of 317 consecutive patients with LBP referred for MRI completed an SF-36 health status questionnaire immediately before imaging and again 6 months later. Patients were grouped according to the most extensive disc abnormality and any neural compromise reported at MRI. The relationship between symptoms, radiological signs and SF-36 scores was assessed. Eighty percent (255/317) and 65% (205/317) of patients completed the initial and 6-month SF-36, respectively. Thirty-six percent of patients (115/317) had one or more herniated discs and 44% (140/317) had neural impingement. There was little relationship between the extent of disc abnormality and quality of life. Patients with radiological evidence of neural impingement reported better general health (P < 0.01). SF-36 scores improved at 6 months in four dimensions, but general health deteriorated (P < 0.01). Patients with neural impingement had improved pain scores at 6 months (P < 0.05). The study results showed that the pain and dysfunction caused by disc herniation and neural compromise are not sufficiently distinct from other causes of back pain to be distinguished by the SF-36. Whilst neural compromise may be the best radiological feature distinguishing patients who may benefit from intervention, it cannot predict quality of life deficits in the diffuse group of patients with LBP.

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Section: Interpretation Of Resultsmentioning

confidence: 98%

“…There is widespread variation in surgical management for low back pain [25]. Although surgery is very effective in selected patients [1,27], symptoms may improve without it [4,23] and surgery still fails to relieve symptoms in others [7,9]. One reason for this could be inappropriate patient selection [16].…”

Section: Introductionmentioning

confidence: 99%

Self reported health status and magnetic resonance imaging findings in patients with low back pain

Hollingworth

Dixon

Todd

et al. 1998

European Spine Journal

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“…Disc herniations were detected on CT and MR scans in a high percentage of asymptomatic patients [5,16,17,31,32]. Likewise it has been shown that the size of herniations does not correlate with displayed clinical symptoms [6,8,34]. If, despite the lack of sensory or motor losses, the incidental finding of pathologic disc morphology is concluded to be the source of pain, the wrong therapy may be initiated, e.g.…”

Section: Introductionmentioning

confidence: 99%

Sacroiliac joint dysfunction in patients with imaging-proven lumbar disc herniation

Galm

Fröhling

Rittmeister

et al. 1998

European Spine Journal

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IntroductionDisc herniation leading to nerve root displacement with compression and causing radicular symptoms is only one of a variety of possible causes of lumbar and ischiadic pain. Pain radiating into the leg is not necessarily caused by irritation of the root [18,19]; Norman and May [25] identified the sacroiliac joint (SIJ) as one of the possible starting points of such complaints via injection of local anaesthetic. Disc herniations were detected on CT and MR scans in a high percentage of asymptomatic patients [5,16,17,31,32]. Likewise it has been shown that the size of herniations does not correlate with displayed clinical symptoms [6,8, 34]. If, despite the lack of sensory or motor losses, the incidental finding of pathologic disc morphology is concluded to be the source of pain, the wrong therapy may be initiated, e.g. nucleotomy, leading to unsatisfactory postoperative results [7,[28][29][30]. This has to be considered when a choice between surgical and non-surgical treatment is made.The lack of consideration of alternatives to disc-triggered pain is encouraged by the fact that some alternative diagnoses are undetectable by imaging procedures. Functional disorders in general, and dysfunction of the SIJ in specific, cannot be detected by CT or MRI. Reversible Abstract A dysfunction of a joint is defined as a reversible functional restriction of motion presenting with hypomobility according to manual medicine terminology. The aim of our study was to evaluate the frequency and significance of sacroiliac joint (SIJ) dysfunction in patients with low back pain and sciatica and imaging-proven disc herniation. We examined the SIJs of 150 patients with low back pain and sciatica; all of these patients had herniated lumbar disks, but none of them had sensory or motor losses. Forty-six patients, hereinafter referred to as group A, were diagnosed with dysfunction of the SIJ. The remaining 104 patients, hereinafter referred to as group B, had no SIJ dysfunction. Dysfunctions were resolved with mobilizing and manipulative techniques of manual medicine. Regardless of SIJ findings, all patients received intensive physiotherapy throughout a 3-week hospitalisation. At the 3 weeks follow-up, 34 patients of group A (73.9%) reported an improvement of lumbar and ischiadic pain, 5 patients were pain free. Improvement was recorded in 57 of the group B patients (54.8%); however, nobody in group B was free of symptoms. We conclude that in the presence of lumbar and ischiadic symptoms our presented data suggest consideration of SIJ dysfunction, requiring manual medicine examination and, in the presence of SIJ dysfunction, appropriate therapy, regardless of intervertebral disc pathomorphology. This could avoid wrong indications for nucleotomy.

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“…A large population study based in Finland found a lifetime prevalence of 5.3% in men and 3.7% in women [3]. Some cohort studies have reported that most patients will have a resolution of their sciatica over a period of weeks to months, with 30% having persistent, troublesome symptoms at one year with 20% out of work and 5-15% requiring surgery [4,5]. However, another cohort study found that 55% still had symptoms of sciatica two years later, and 53% after four years (which included 25% who had recovered after two years but had relapsed by four years) [6].…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of different strategies to manage patients with sciatica

Fitzsimmons

Phillips

Bennett

et al. 2014

Pain

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SummaryA model-based economic evaluation demonstrates that stepped approaches based on initial treatment with non-opioids are most likely to represent the most cost-effective regimens for sciatica. 2 AbstractThe aim of this paper is to estimate the relative cost-effectiveness of treatment regimens for managing patients with sciatica. A deterministic model structure was constructed, based on information from the findings from a systematic review of clinical and cost-effectiveness, published sources of unit costs and expert opinion. The assumption was patients presenting with sciatica would be managed through one of three pathways (primary care, stepped approach, immediate referral to surgery).. Results were expressed as incremental cost per patient with symptoms successfully resolved. Analysis also included incremental cost per utility gained over a 12 month period. One-way sensitivity analyses were used to address uncertainty. The model demonstrated that none of the strategies resulted in 100% success. For initial treatments, the most successful regime in the first pathway was non-opioids, with a probability of success of 0.613. In the second pathway, the most successful strategy was non-opioids, followed by biological agents, followed by epidural/nerve block and disc surgery, with a probability of success of 0.996. Pathway 3 (immediate surgery) was not cost-effective. Sensitivity analyses identified that the use of the highest cost estimates results in a similar overall picture. While the estimates of cost per QALY are higher, the economic model demonstrated that stepped approaches based on initial treatment with non-opioids are likely to represent the most cost-effective regimens for the treatment of sciatica. However, development of alternative economic modelling approaches is required.3

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The Natural History of Sciatica Associated with Disc Pathology: A Prospective Study with Clinical and Independent Radiologic Follow-Up

Cited by 98 publications

References 0 publications

Self reported health status and magnetic resonance imaging findings in patients with low back pain

Self reported health status and magnetic resonance imaging findings in patients with low back pain

Sacroiliac joint dysfunction in patients with imaging-proven lumbar disc herniation

Cost-effectiveness of different strategies to manage patients with sciatica

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