THE MAINE LUMBAR SPINE STUDY .2. 1-YEAR OUTCOMES OF SURGICAL AND NONSURGICAL MANAGEMENT OF SCIATICA

Study Design. The Maine Lumbar Spine Study is a prospective cohort stu dy of patients recruited from the practices of orthopedic surgeons, ne urosurgeons, and occupational medicine physicians throughout Maine. Ob jective. To assess 1-year outcomes of patients with sciatica believed to be due to a herniated lumbar disc treated surgically or nonsurgical ly. Summary of Background Data. Lumbar spine surgery rates very by geo graphic region and may reflect uncertainty about optimal clinical use. Methods. Eligible consenting patients participated in a baseline inte rview performed by study personnel and then were mailed follow-up ques tionnaires at 3, 6, and 12 months. Clinical data were obtained from a physician questionnaire. Outcomes included patient-reported symptoms o f leg and back pain, functional status, disability, quality of life, a nd satisfaction with care. Results. Five hundred seven patients with s ciatica 275 treated surgically and 232 treated nonsurgically initially , were enrolled. Surgically treated patients, on average, had more sev ere symptoms and had more severe physical and imaging findings than no nsurgically treated patients had severe symptoms, about half in each t reatment group had symptoms that fell into a moderate category. At the 1-year evaluation, improvement in symptoms, functional status, and di sability were found in both treatment groups. However, surgically trea ted patients reported significantly greater improvement. For the predo minant symptom, either back or leg pain, 71% of surgically treated and 43% of nonsurgically treated patients reported definite improvement ( P < 0.001). This effect was even greater after adjustment for differen ces between treatment groups at entry (relative odds of definite impro vement, 4.3; P < 0.001). For patients with moderate symptoms and abnor mal physical examination findings, surgical treatment also resulted in greater improvement than non-surgical treatment. However, there was l ittle difference in the employment or workers' compensation status of patients treated surgically versus nonsurgically (5% vs. 7% unemployed at 1-year follow-up if employed at entry [P = 0.68]; 46% vs. 55% rece iving workers' compensation at 1-year follow-up if receiving it at ent ry [P = 0.30] for surgical and nonsurgical management, respectively). For patients with mild symptoms, the benefits of surgical and nonsurgi cal treatment were similar. Conclusions. Although surgically treated p atients were on a average more symptomatic at entry, there was substan tial overlap in symptoms between surgically treated and nonsurgically treated patients. Surgically treated patients with sciatica reported s ubstantially greater improvement at 1-year follow-up. However, employm ent and compensation outcomes were similar between the two treatment g roups, and surgery appeared to provide little advantage for the subset of patients with mild symptoms. These results should be interpreted c autiously, because surgical treatment was not assigned randomly. Long- term follow-up will determine if these differences persist.