CEREBROSPINAL-FLUID PROTEIN CONCENTRATIONS IN PATIENTS WITH SCIATICA CAUSED BY LUMBAR DISC HERNIATION - AN INVESTIGATION OF BIOCHEMICAL, NEUROLOGIC, AND RADIOLOGIC PREDICTORS OF LONG-TERM OUTCOME

We studied 180 adult patients admitted to the Neurological Department, Haukeland Hospital in Bergen, Norway, for a period of 5 years from 19 84 to 1988. One hundred fifty-seven patients were followed up 3.9-9.0 years after admittance to the Neurological Department. The purpose of this study was to find out if the total cerebrospinal fluid (CSF) prot ein concentration could predict the outcome of lumbar disc surgery or conservative treatment in patients with sciatica Neurologic and radiol ogic parameters were also included in the investigation. The increase of the CSF total protein concentration in sciatica without spinal bloc k is assumed to be due to leak of plasma proteins into the CSF from th e nerve root. A relationship between CSF protein concentrations and ce rtain clinical parameters has been found. At myelography, 10 mi of CSF was collected for analysis. The patients were evaluated for involve m ent of the nerve root and/or the dural sac, respectively. The neurolog ic parameters investigated were: straight leg raising tests, paresis, disturbances of sensibility, and altered reflexes. At follow-up, the p atients were asked to fill in questionnaires concerning job function, sick leave or disability pension, subjective physical disability and p ain perception, and a clinical examination with the same neurologic pa rameters was performed. Elevated CSF total protein concentration was r elated to chronic leg pain, leg pain, and subjective physical disabili ty at follow-up. Nonoperated women reported higher subjective physical disability scores and were more often on sick-leave or disability pen sion than were men at follow-up. Lateral prolapses were associated wit h good job function outcome and less risk for sick-leave or disability pension. Reduced lower extremity reflexes, laterally located disc her niation and elevated CSF total protein concentration were associated w ith a favorable long-term outcome in patients with sciatica. CSF prote ins as objective measures on nerve root injury are discussed. CSF tota l protein concentration can be regarded as an indicator of the functio nal status of the nerve root and a prognostic factor in patients with sciatica.