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Logo of bmcmudisBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Musculoskeletal Disorders
 
BMC Musculoskelet Disord. 2012; 13: 183.
Published online Sep 22, 2012. doi:  10.1186/1471-2474-13-183
PMCID: PMC3495213
Prognostic factors for non-success in patients with sciatica and disc herniation
Anne Julsrud Haugen,corresponding author1 Jens Ivar Brox,2 Lars Grøvle,1 Anne Keller,3 Bård Natvig,4,5 Dag Soldal,6 and Margreth Grotle4,7
1Department of Rheumatology, Østfold Hospital Trust, Fredrikstad, Norway
2Section for Back Surgery and Physical Medicine and Rehabilitation, Orthopaedic Department, Oslo University Hospital, Rikshospitalet, Oslo, Norway
3Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ullevål, Oslo, Norway
4National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
5Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
6Department of Rheumatology, Sørlandet Hospital Health Enterprise, Kristiansand, Norway
7FORMI (Communication Unit for Musculoskeletal Disorders), Division of Neuroscience, Oslo University Hospital, Ullevål, Oslo, Norway
corresponding authorCorresponding author.
Anne Julsrud Haugen: annhau/at/so-hf.no; Jens Ivar Brox: j.i.brox/at/medisin.uio.no; Lars Grøvle: largro/at/so-hf.no; Anne Keller: akel0008/at/regionh.dk; Bård Natvig: bard.natvig/at/medisin.uio.no; Dag Soldal: dag.magnar.soldal/at/sshf.no; Margreth Grotle: margreth.grotle/at/medisin.uio.no
Received January 20, 2012; Accepted September 19, 2012.
Abstract
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.
Keywords: Sciatica, Disc herniation, Prognostic factors, Non-success
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