THE QUEBEC TASK-FORCE CLASSIFICATION FOR SPINAL-DISORDERS AND THE SEVERITY, TREATMENT, AND OUTCOMES OF SCIATICA AND LUMBAR SPINAL STENOSIS

Study Design. A prospective cohort study of patients in Maine with sci atica and lumbar spinal stenosis treated surgically and nonsurgically. Summary of Background Data. In 1987, the Quebec Task Force on Spinal Disorders proposed a diagnostic classification to help make clinical d ecisions, evaluate quality of care, assess prognosis, and conduct rese arch. Objectives. To assess the Quebec Task Force classification's abi lity to stratify patients according to severity and treatment al basel ine, and to assess changes over time in health-related quality of life , including symptoms, functional status, and disability. Methods. Five hundred sixteen patients participating in the Maine Lumbar Spine Stud y who completed baseline and 1-year follow-up evaluations were classif ied successfully according to the Quebec Task Force classification. Pa tient characteristics and treatments were compared across Quebec Task Force classification categories. Changes in health-related quality of life over 1 year were assessed according to Quebec Task Force classifi cation category and type of treatment. Results. Among patients with sc iatica (n = 370), higher Quebec Task Force classification categories ( from 2, pain radiating to the proximal extremity, to 6, sciatica with evidence of nerve root compression) were associated with increased sev erity of symptoms at baseline. There was no association between Quebec Task Force classification and baseline functional status. Quebec Task Force classification was associated strongly with the likelihood of r eceiving surgical treatment (P less than or equal to 0.005). Among pat ients with sciatica treated nonsurgically, improvement at 1 year in ba ck-specific and generic physical function increased with higher Quebec Task Force classification category (P less than or equal to 0.05). On ly a nonsignificant trend was observed for surgically treated patients . Patients with lumbar spinal stenosis (Quebec Task Force classificati on 7, n = 131) had baseline features and outcomes distinct from patien ts with sciatica. Conclusions. For patients with sciatica, the Quebec Task Force classification was-highly associated with the severity of s ymptoms and the probability of subsequent surgical treatment. Nonsurgi cally treated patients in Quebec Task Force classification categories reflecting nerve root compression had greater improvement than those w ith pain symptoms alone. Among surgical patients, the Quebec Task Forc e classification was not associated with Outcome. These results provid e validation for the classification and its wider adoption. Nonetheles s, improved diagnostic classifications are needed to predict outcomes better in patients with sciatica who undergo surgery.