THE PREDICTIVE VALUE OF THE DURATION OF RADICULOPATHY FOR LUMBAR DISC SURGERY – A PROSPECTIVE COHORT STUDY

Abstract

To evaluate prognostic factors that influence outcome particularly those related to duration of symptoms in surgery for lumbar radiculopathy, #2

In primary care 75% of patients are pain free after the onset of sciatica within 28 days. The optimum timing of surgery for unresolved leg pain secondary to herniated lumbar disc is unclear.

#2 We prospectively recruited 113 patients in this study and at one year, the follow up was available on 103 (91%). We investigated the prognostic value of a number of variables. These included the duration of sciatic symptoms, age at operation, Modified Zung Depression Score (MZD) and Modified Somatic Perception Score (MSP) using multiple regression analysis. The outcome was measured by the change of the Oswestry Disability Index (ODI), Low Back Outcome Score (LBOS) and of the Visual Analogue Scale (VAS). Patients with contained and non-contained herniated disc were compared.

The change in ODI is statistically significantly associated with the duration of sciatica symptoms (p=0.05) with a one-month increase in the duration of symptoms being associated with a decrease in the change of ODI of 0.6% (95% CI, −1.014 to −0.187). The duration of sciatica and the MZD are associated with significant reduction in LBOS (p=0.034 and 0.028 respectively). VAS was not significantly associated with all the prognostic factors investigated.

A shorter duration of sciatic symptoms was associated with a greater degree of patients’ outcome satisfaction. Non-contained herniated disc had a shorter duration of symptoms and a better functional outcome compared to contained herniated disc. Unemployment and smoking were not risk factors for poor surgical outcome.

Conclusion: Our study indicates that the duration of radicular pain of more than 12 months has a less favourable outcome. Patient’s satisfaction is greatest if surgery occurs within one year.