Influence of low back pain and prognostic value of MRI in sciatica patients in relation to back pain

Abdelilah el Barzouhi, Carmen L A M Vleggeert-Lankamp, Geert J Lycklama à Nijeholt, Bas F Van der Kallen, Wilbert B van den Hout, Bart W Koes, Wilco C Peul, Leiden–The Hague Spine Intervention Prognostic Study Group, B W Koes, W B van den Hout, R T W M Thomeer, W C Peul, A el Barzouhi, W B van den Hout, W C Peul, M Nuyten, P Bergman, G Holtkamp, S Dukker, A Mast, L Smakman, C Waanders, L Polak, A Nieborg, C L A M Vleggeert-Lankamp, G J Lycklama à Nijeholt, B F Van der Kallen, A el Barzouhi, W B van den Hout, A el Barzouhi, C L A M Vleggeert-Lankamp, G J Lycklama à Nijeholt, B F Van der Kallen, W B van den Hout, B W Koes, W C Peul, A el Barzouhi, C L A M Vleggeert-Lankamp, G J Lycklama à Nijeholt, B F Van der Kallen, W B van den Hout, B W Koes, W C Peul, A el Barzouhi, C L A M Vleggeert-Lankamp, G J Lycklama à Nijeholt, B F Van der Kallen, W B van den Hout, B W Koes, W C Peul, A el Barzouhi, C L A M Vleggeert-Lankamp, G J Lycklama à Nijeholt, B F Van der Kallen, W B van den Hout, B W Koes, W C Peul, W C Peul, B W Koes, R T W M Thomeer, B W Koes, R T W M Thomeer, J A H Eekhof, J T J Tans, W B van den Hout, W C Peul, R Brand, H C van Houwelingen, J T J Tans, R Walchenbach, J van Rossum, P Schutte, R T W M Thomeer, G A M Verheul, J E Dalman, J A L Wurzer, J W A Sven, A Kloet, I S J Merkies, H van Dulken, P C L A Lambrechts, J A L Wurzer, R W M Keunen, C F E Hoffmann, J Haan, H van Dulken, R Groen, R R F Kuiters, R A C Roos, J H C Voormolen, J A H Eekhof, Abdelilah el Barzouhi, Carmen L A M Vleggeert-Lankamp, Geert J Lycklama à Nijeholt, Bas F Van der Kallen, Wilbert B van den Hout, Bart W Koes, Wilco C Peul, Leiden–The Hague Spine Intervention Prognostic Study Group, B W Koes, W B van den Hout, R T W M Thomeer, W C Peul, A el Barzouhi, W B van den Hout, W C Peul, M Nuyten, P Bergman, G Holtkamp, S Dukker, A Mast, L Smakman, C Waanders, L Polak, A Nieborg, C L A M Vleggeert-Lankamp, G J Lycklama à Nijeholt, B F Van der Kallen, A el Barzouhi, W B van den Hout, A el Barzouhi, C L A M Vleggeert-Lankamp, G J Lycklama à Nijeholt, B F Van der Kallen, W B van den Hout, B W Koes, W C Peul, A el Barzouhi, C L A M Vleggeert-Lankamp, G J Lycklama à Nijeholt, B F Van der Kallen, W B van den Hout, B W Koes, W C Peul, A el Barzouhi, C L A M Vleggeert-Lankamp, G J Lycklama à Nijeholt, B F Van der Kallen, W B van den Hout, B W Koes, W C Peul, A el Barzouhi, C L A M Vleggeert-Lankamp, G J Lycklama à Nijeholt, B F Van der Kallen, W B van den Hout, B W Koes, W C Peul, W C Peul, B W Koes, R T W M Thomeer, B W Koes, R T W M Thomeer, J A H Eekhof, J T J Tans, W B van den Hout, W C Peul, R Brand, H C van Houwelingen, J T J Tans, R Walchenbach, J van Rossum, P Schutte, R T W M Thomeer, G A M Verheul, J E Dalman, J A L Wurzer, J W A Sven, A Kloet, I S J Merkies, H van Dulken, P C L A Lambrechts, J A L Wurzer, R W M Keunen, C F E Hoffmann, J Haan, H van Dulken, R Groen, R R F Kuiters, R A C Roos, J H C Voormolen, J A H Eekhof

Abstract

Background: Patients with sciatica frequently complain about associated back pain. It is not known whether there are prognostic relevant differences in Magnetic Resonance Imaging (MRI) findings between sciatica patients with and without disabling back pain.

Methods: The study population contained patients with sciatica who underwent a baseline MRI to assess eligibility for a randomized trial designed to compare the efficacy of early surgery with prolonged conservative care for sciatica. Two neuroradiologists and one neurosurgeon independently evaluated all MR images. The MRI readers were blinded to symptom status. The MRI findings were compared between sciatica patients with and without disabling back pain. The presence of disabling back pain at baseline was correlated with perceived recovery at one year.

Results: Of 379 included sciatica patients, 158 (42%) had disabling back pain. Of the patients with both sciatica and disabling back pain 68% did reveal a herniated disc with nerve root compression on MRI, compared to 88% of patients with predominantly sciatica (P<0.001). The existence of disabling back pain in sciatica at baseline was negatively associated with perceived recovery at one year (Odds ratio [OR] 0.32, 95% Confidence Interval 0.18-0.56, P<0.001). Sciatica patients with disabling back pain in absence of nerve root compression on MRI at baseline reported less perceived recovery at one year compared to those with predominantly sciatica and nerve root compression on MRI (50% vs 91%, P<0.001).

Conclusion: Sciatica patients with disabling low back pain reported an unfavorable outcome at one-year follow-up compared to those with predominantly sciatica. If additionally a clear herniated disc with nerve root compression on MRI was absent, the results were even worse.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Repeated measurement analysis curve of…
Figure 1. Repeated measurement analysis curve of Mean Scores for back pain on the Visual-Analogue Scale.
Sciatica patients with both disabling back pain and nerve root compression on MRI were compared with patients with disabling back pain but who did not depict nerve root compression on MRI at baseline. The vertical bars represent 95% confidence intervals.

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