2012 Research: Predictive Factors For Poor Outcome With Sciatica

Predicting Sciatica Outcomes

Sciatica Relief: Looking Into Your Future

I have just finished reading some hot off the press research on sciatica leg pain and low back pain out of Norway. In this study the researchers were trying to see what things they could see could cause a patient with lower back pain and sciatica to not respond well.

The authors came up with some pointers to consider if someone is suffering this trapped nerve in the leg condition. What was also interesting is that back surgery did not have an amazing success rate as they had expected it might. If you or a loved one has a trapped nerve in their back going down the back of the leg, maybe to the foot, you’ll probably like to read this article.

Sciatica Relief Factors: 2012 Research

The research paper I’m referring to is by Haugen et al. published in the journal BMC Musculoskeletal Disorders. The researchers took 466 patients who had low back pain and leg pain. Did an MRI scan confirming a lumbar disc herniation on the side of pain, and followed them for two years to see the outcome. Read the full article for free below:

Download (PDF, 335KB)

This study’s two main aims were:

  1. “Identify the prognostic factors associated with non-success after 1 and 2 years of follow-up for sciatica and disc herniation in patients referred for secondary care.”
  2. “To test the prognostic value of surgical treatment for sciatica.”

That means try predict what causes people to still feel pain 1-2 years later after going to a hospital for an evaluation and treatment. How good back surgery on the disc herniation is for pain relief 1-2 years later.

How Sciatica Was Diagnosed

The way sciatica was clinically diagnosed was if:

  • Abnormal motor function present meaning couldn’t raise the big toe or bend or straighten the knee or ankle like the other leg.
    https://www.youtube.com/watch?v=vIIbtTc31lw
  • Positive Trendelenburg test is when you stand on one leg and your pelvis tilts like in this video:
    https://www.youtube.com/watch?v=TY-G4ErruUA
  • Difficulty with heel and tip toe walking, like this video:
    https://www.youtube.com/watch?v=-qwEU8dU8mo
  • Decreased sensation to light touch and pin prick sensation (tactile sensibility)
  • Asymmetrical Achilles or patella deep tendon reflexes in the sciatica leg:
    https://www.youtube.com/watch?v=4dUH2Rv4fQk
  • Positive straight leg raise test causing same sciatica feeling in the leg:
    http://www.youtube.com/watch?v=sTIPOKhAzZM

There were also questionnaires which were the way they worked out non-successful outcome which were the Maine–Seattle Back Questionnaire (MSBQ) and the Sciatica Bothersomeness Index (SBI).

Results That Got My Attention

There were two sciatica treatment options that patients got in hospital. One was “conservative” which was back exercises, pain-killers and physiotherapy. The other way was “back surgery” with which type of spinal surgery not restricted. Usually low back surgery for a trapped nerve is either called a discetomy or a lumbar spine fusion.

An overall impression concluded between the two questionnaires is:

The conservative treatment, which made up about 2/3rds of the people, had a non-success outcome after one to two years between 39 – 54%.

The spinal surgery treatment had a non-success rate after one to two years between 30 – 39%.

Overall if a patient went to hospital to try fix their trapped nerve pain then after one year 44%–47% had no good relief and after two years 39%–42% still had no relief.

So the authors concluded that secondary care, or getting typical hospital treatment, for sciatica pain in the leg is not as good as they thought.

Spinal surgery got slightly better results at one to two years after the study began, but was very variable for results.

You Won’t Get Better If

In this study the best predictors that a patient with sciatica pain from a lumbar disc herniation won’t recover well are:

  1. If they are a male
  2. They are a current smoker
  3. Had the most back pain
  4. Didn’t get back surgery in the first year
  5. Scared of moving (kinesiophobia)

A point not particularly highlighted but one I find really interesting was that no sciatica specific clinical finding was related to a poor outcome. Except a weak association with an abnormal reflex in the achilles or patella tendons. However, in my experience, if you have had an episode of a severe lumbar radiculopathy from a herniated lumbar disc then it is likely you will be left with abnormal deep tendon reflexes after.

You might ask why I found that one point interesting. It was that most of the time patients are referred for an orthopaedic or neurosurgeon surgical consult because of severe sciatica pain and signs of leg nerve function getting worse like weakness + abnormal reflexes. For example, a weak big toe extension (extensor hallucis longus) and dropped ankle jerk reflex might not have such a strong relationship to a poor outcome down the line. Hmmm.

Do you really need back surgery quickly for sciatica then because you have weakness in your leg muscles initially?

It has always been such a grey area when deciding who qualifies for a back surgery procedure when they have a lumbar disc herniation and radiculopathy down the leg. For me my biomarkers for possible surgery time for sciatica, other than obvious surgery if bowel and bladder changes, is:

  • Pain not getting better with trapped nerve pain killers
  • Pain not getting better with conservative treatment
  • Muscle weakness in the foot. More serious if increasing to point of foot drop

As you may read pain is a major factor for predicting a reason for low back surgery. A neurosurgeon once told me most low back surgery is done to relieve pain levels. Back surgery can be good for giving quick pain relief, but remember there are people with failed back surgery syndrome. I mentioned how smoking and obesity are major predictors for a reoccurring disc herniation after a successful back surgery.

The Bottom Line

If your reading this post with a sciatica pain in your bum running down your leg and your thinking should I get surgery to relieve the pain I hope this latest study helps you. Smoking seems terrible for sore low backs and disturbs healing. So, if you can, stop smoking. It could just save your back. If you’re in the UK maybe find a neurological hospital in your area who should have doctors and physiotherapists and occupational therapists more ready to deal with sciatica.

Image CreditSome rights reserved by Steven | Alan

Further Reading:

  1. Haugen AJ, Brox JI, Grovle L, Keller A, Natvig B, Soldal DM, Grotle M. Prognostic factors for non-success in patients with sciatica and disc herniation. BMC Musculoskelet Disord. 2012 Sep 22;13(1):183.