Magnetic Resonance Imaging Findings as Predictors of Clinical Outcome in Patients With Sciatica Receiving Active Conservative Treatment
Received 10 July 2006; received in revised form 17 August 2006; accepted 24 August 2006.
Abstract
Objective
The aims of this study were to investigate the possible prognostic value of disk-related magnetic resonance imaging (MRI) findings in relation to recovery at 14 months in patients with severe sciatica, and whether improvement of disk herniation and/or nerve root compromise is concurrent with recovery.
Methods
All patients included in this prospective observational study of patients with sciatica receiving active conservative treatment were scanned at baseline and at 14 months' follow-up. Definite recovery at follow-up was defined as an absence of sciatic leg pain and a Roland Morris disability score of 3 or less. Potential predictors of interest were disk-related MRI findings in the lumbar spine. Bi- and multivariate logistic regression analyses were used to identify any predictors of recovery. Age, sex, and treatment were included in the analyses as possible confounding/modifying factors.
Results
According to the definitions used, 53% of 154 patients recovered; 63% of men (n = 84) and 40% of women (n = 70). In the multivariate analyses, broad-based protrusions, extrusions, and male sex were found to be predictive of a positive outcome. Sex was identified as a true confounder in that the prevalence of disk-related MRI findings was different for men and women, and they had different recovery rates. Improvement of disk herniations and nerve root compromise over time did not coincide with definite recovery.
Conclusions
In patients with sciatica receiving active conservative treatment, broad-based protrusions and extrusions at baseline were positive predictors of definite recovery at 14 months. However, at 14 months the MRI-defined improvement of disk herniations and nerve root compromise was not correlated with definite recovery.
aChiropractor, The Back Research Center, Ringe, University of Southern Denmark, Odense, and Clinical Locomotion Science, Denmark
bSenior researcher, The Back Research Center, Ringe, University of Southern Denmark, Odense, and Clinical Locomotion Science, Denmark
cRadiologist, The Back Research Center, Ringe, University of Southern Denmark, Odense, and Clinical Locomotion Science, Denmark
dHead of Department, Backcenter Funen, Ringe and Professor, The Back Research Center, Ringe, University of Southern Denmark, Odense, and Clinical Locomotion Science, Denmark
eResearch Professor, The Back Research Center, Ringe, University of Southern Denmark, Odense, and Clinical Locomotion Science, Denmark
Submit requests for reprints to: Tue Secher Jensen, DC, MSc, The Back Research Center, University of Southern Denmark, Backcenter Funen, Lindevej 5, DK-5750 Ringe, Denmark.
ABSTRACT