Predicting Results of Surgery for SciaticaIt is well-known that disc protrusion can cause back pain that travels down the leg. This condition is called lumbar radiculopathy. It is more commonly referred to as sciatica.
When conservative care fails to relieve symptoms, surgery may be the next step. About 80 per cent of the patients treated surgically for lumbar radiculopathy get good results. But what about the other 20 per cent? Why don't they get a positive outcome?
In this study, researchers use a group of tests to predict success. If it could be possible to predict who won't be helped by surgery, then patients in that 20 per cent group could be spared the procedure.
All patients in the study had failed at least six weeks of conservative care. Imaging studies showed they all had signs and symptoms from pressure on a single spinal nerve. The pressure was caused by a bone spur, disc herniation, or cyst.
Everyone filled out a survey before surgery and then each time they were seen in follow-up after surgery. There were six assessment tools that asked questions about general health, psychologic distress, and emotional factors. All six questionnaires are discussed in detail. These included two parts of the McGill Pain Questionnaire, the Visual Analogue Scale, two parts of the Prolo Scale, and the Ransford Pain Drawing Score.
The authors knew from previous studies that psychosocial issues affect treatment outcomes. They were surprised by the strength and magnitude of their negative effects on surgical results.
Using these tools, it was easier to predict failure than improvement with treatment. The McGill and Ransford tools were the most helpful. Negative predictive factors included sciatica accompanied by joint pain in the legs. Psychiatric factors or personal injury or compensation claims were also predictors of a negative outcome.
The authors conclude that patients should not be denied surgery based on these factors. But surgeons may want to change what they tell patients, referring physicians, and other third party payers. For example, predictions of success are very conservative. And if surgery fails in the presence of these factors, then revision surgery is not advised.
Rand M. Voorhies, MD, et al. Predicting Outcome in the Surgical Treatment of Lumbar Radiculopathy Using the Pain Drawing Score, McGill Short Form Pain Questionnaire, and Risk Factors Including Psychosocial Issues and Axial Joint Pain. In The Spine Journal. November 2007. Vol. 7. No. 5. Pp. 516-524.
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