Recovery of severe sciatica

Study Design. A prospective study of patients with acute severe sciatica. Objectives. To 1) describe the characteristics of patients with acute sever e sciatica and the agreement among different diagnostic tests, 2) describe overall recovery during 1 year in terms of perceived disability, and pain, and 3) explore acute-phase predictors of failure to recover at 1 year. Summary of Background Data. The development of imaging techniques has been very impressive during recent decades. However, different authors have high -lighted the prevalence of abnormal images among asymptomatic subjects. The se findings increase the difficulty of interpreting the results from the di agnostic techniques used with each individual patient. Furthermore, other c linical and biopsychosocial variables need to be explored for their associa tions with recovery or failure to recover. This study aimed to explore thos e associations. Methods. Consecutive patients admitted to the hospital for conservative man agement of severe acute sciatica were eligible for inclusion in the study. Patients were evaluated at admission, discharge, and 3, 6, and 12 months. A ll the visits included a standardized clinical examination and the completi on of questionnaires that included items on demographics, pain perceived di sability, and quality of life. Imaging and blood samples were collected at the first visit, and an electromyogram was taken for sciatica lasting at le ast 3 weeks. Results. The study included 82 consecutive patients (66% men) with a mean a ge of 43 +/- 10.3 years. The mean intensity of pain, on a visual analog sca le of 0 to 100 (VAS) at Visit 1, was 73. The straight leg raising test was positive in 78% of the patients, with a mean value of 59 degrees +/- 18 deg rees. The contralateral straight leg raising test was positive in 20% of th e patients. Imaging was positive for disc herniation in 74% and electromyog ram was positive in 62% of cases. These two diagnostic tests showed a good to excellent total agreement (58-87%) with the straight leg raising tests a nd the presence of radiating pain below the knee. The recovery of clinical symptoms and signs was observed mainly within the first 3 months. However, clinical recovery and perceived recovery was not complete in most cases. Conclusions. In most cases, there was good to excellent agreement among the different diagnostic tests. None of the tests was predictive of recovery. The presence of blood antibodies against 3'LM1 (IgM + IgG) and GD1a (IgM) w as significantly associated (P < 0.023) with neurologic symptoms and signs. However, the meaning of these antibodies remains unclear. Only a minority of the patients (29%) had fully recovered after 12 months. Within the 1-yea r follow-up, one third of the patients had surgery.