Magnetic resonance imaging in follow-up assessment of sciatica
Abdelilah el Barzouhi, Carmen L A M Vleggeert-Lankamp, Geert J Lycklama à Nijeholt, Bas F Van der Kallen, Wilbert B van den Hout, Wilco C H Jacobs, 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, R Brand, A el Barzouhi, C L A M Vleggeert-Lankamp, G J Lycklama à Nijeholt, B F Van der Kallen, W B van den Hout, W C H Jacobs, 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, W C H Jacobs, 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, W C H Jacobs, 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, W C H Jacobs, 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, Wilco C H Jacobs, 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, R Brand, A el Barzouhi, C L A M Vleggeert-Lankamp, G J Lycklama à Nijeholt, B F Van der Kallen, W B van den Hout, W C H Jacobs, 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, W C H Jacobs, 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, W C H Jacobs, 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, W C H Jacobs, 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: Magnetic resonance imaging (MRI) is frequently performed during follow-up in patients with known lumbar-disk herniation and persistent symptoms of sciatica. The association between findings on MRI and clinical outcome is controversial.
Methods: We studied 283 patients in a randomized trial comparing surgery and prolonged conservative care for sciatica and lumbar-disk herniation. Patients underwent MRI at baseline and after 1 year. We used a 4-point scale to assess disk herniation on MRI, ranging from 1 for "definitely present" to 4 for "definitely absent." A favorable clinical outcome was defined as complete or nearly complete disappearance of symptoms at 1 year. We compared proportions of patients with a favorable outcome among those with a definite absence of disk herniation and those with a definite, probable, or possible presence of disk herniation at 1 year. The area under the receiver-operating-characteristic (ROC) curve was used to assess the prognostic accuracy of the 4-point scores regarding a favorable or unfavorable outcome, with 1 indicating perfect discriminatory value and 0.5 or less indicating no discriminatory value.
Results: At 1 year, 84% of the patients reported having a favorable outcome. Disk herniation was visible in 35% with a favorable outcome and in 33% with an unfavorable outcome (P=0.70). A favorable outcome was reported in 85% of patients with disk herniation and 83% without disk herniation (P=0.70). MRI assessment of disk herniation did not distinguish between patients with a favorable outcome and those with an unfavorable outcome (area under ROC curve, 0.48).
Conclusions: MRI performed at 1-year follow-up in patients who had been treated for sciatica and lumbar-disk herniation did not distinguish between those with a favorable outcome and those with an unfavorable outcome. (Funded by the Netherlands Organization for Health Research and Development and the Hoelen Foundation; Controlled Clinical Trials number, ISRCTN26872154.).
Source: PubMed