Is it possible to predict the efficacy at discharge of inhospital rheumatology department management of disk-related sciatica? A study in 150 patients

Objectives. To identify criteria for predicting the outcome at discharge in patients scheduled for inhospital treatment of disk-related sciatica. Pati ents and methods. We studied 150 rheumatology department patients admitted for disk-related sciatica with a mean duration of 88+/-127 days to determin e the impact on treatment outcomes of 50 parameters. Results. After complet e bed and 2.2+/-1.1 epidural glucocorticoid injections during a mean hospit al stay of 9.9+/-4.3 days, 80% of patients reported either complete or part ial pain relief (19% and 61%, respectively). The remaining 20% reported lit tle (9%) or no (11%) change. Surgery was performed in 13% of cases. A tight er straight-leg raising test angle was correlated with treatment failure (P =0.01). Complete bed rest duration prior to admission was shorter in the 80 % of responders (P=0.036) than in the 20% of nonresponders; in the overall population, patients spent on average 64%+/-33% of daytime hours in bed. Pa tient predictions about their own outcomes were unreliable (P=0.926), Patie nts who believed strongly that sciatica requires surgical treatment were mo re likely to be nonresponders (P=0.06), as were patients with a family hist ory of surgically-treated sciatica (P=0.055). Outcomes were not correlated with any of the other parameters studied, including sciatica duration (P=0. 13), bedrest duration prior to admission (P=0.52; mean duration, 18+/-29 da ys), the specialty of the physicians seen, investigations done prior to adm ission, or a history of sciatica (noted in 65% of cases and treated surgica lly in 16%). Conclusions. Eighty percent of patients benefited from their h ospital stay, Patient opinions on the merits of nonsurgical and surgical tr eatments in their own case were not correlated with their own outcomes. A t ight straight leg-raising test angle was correlated with a poorer outcome. Neither sciatica duration nor rest duration prior to admission had an influ ence on outcome. Absence of complete bed rest prior to admission was correl ated with a greater likelihood of a therapeutic benefit from the hospital s tay.