Magnetic Resonance Imaging in Follow-up Assessment of Sciatica

被引:86
作者
el Barzouhi, Abdelilah [1 ]
Vleggeert-Lankamp, Carmen L. A. M. [1 ]
Nijeholt, Geert J. Lycklama A. [3 ]
Van der Kallen, Bas F. [3 ]
van den Hout, Wilbert B. [2 ]
Jacobs, Wilco C. H. [1 ]
Koes, Bart W. [5 ]
Peul, Wilco C. [1 ,4 ]
机构
[1] Leiden Univ, Med Ctr, Dept Neurosurg, NL-2300 RC Leiden, Netherlands
[2] Leiden Univ, Med Ctr, Dept Med Decis Making, NL-2300 RC Leiden, Netherlands
[3] Med Ctr Haaglanden, Dept Radiol, The Hague, Netherlands
[4] Med Ctr Haaglanden, Dept Neurosurg, The Hague, Netherlands
[5] Univ Med Ctr, Erasmus Med Ctr, Dept Gen Practice, Rotterdam, Netherlands
关键词
LOW-BACK-PAIN; LUMBAR DISC HERNIATION; PROLONGED CONSERVATIVE TREATMENT; PERIDURAL SCAR; FUNCTIONAL STATUS; NATURAL-HISTORY; SURGERY; DISKECTOMY; MICRODISCECTOMY; ASSOCIATION;
D O I
10.1056/NEJMoa1209250
中图分类号
R5 [内科学];
学科分类号
100201 [内科学];
摘要
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.)
引用
收藏
页码:999 / 1007
页数:9
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