Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 Year results from the Maine lumbar spine study

Steven J. Atlas, Robert B. Keller, Yen A. Wu, Richard (Rick) Deyo, Daniel E. Singer

Research output: Contribution to journalArticle

290 Citations (Scopus)

Abstract

Study Design. A prospective cohort study. Objective. To assess 10-year outcomes of patients with sciatica resulting from a lumbar disc herniation treated surgically or nonsurgically. Summary of Background Data. There is little information comparing long-term outcomes of surgical and conservative therapy of lumbar disc herniation in contemporary clinical practice. Prior studies suggest that these outcomes are similar. Methods. Patients recruited from the practices of orthopedic surgeons, neurosurgeons, and occupational medicine physicians throughout Maine had baseline interviews with follow-up questionnaires mailed at regular intervals over 10 years. Clinical data were obtained at baseline from a physician questionnaire. Primary analyses were based on initial treatment received, either surgical or nonsurgical. Secondary analyses examined actual treatments received by 10 years. Outcomes included patient-reported symptoms of leg and back pain, functional status, satisfaction, and work and disability compensation status. Results. Of 507 eligible consenting patients initially enrolled, 10-year outcomes were available for 400 of 477 (84%) surviving patients; 217 of 255 (85%) treated surgically, and 183 of 222 (82%) treated nonsurgically. Patients undergoing surgery had worse baseline symptoms and functional status than those initially treated nonsurgically. By 10 years, 25% of surgical patients had undergone at least one additional lumbar spine operation, and 25% of nonsurgical patients had at least one lumbar spine operation. At 10-year follow-up, 69% of patients initially treated surgically reported improvement in their predominant symptom (back or leg pain) versus 61% of those initially treated nonsurgically (P = 0.2). A larger proportion of surgical patients reported that their low back and leg pain were much better or completely gone (56% vs. 40%, P = 0.006) and were more satisfied with their current status (71% vs. 56%, P = 0.002). Treatment group differences persisted after adjustment for other determinants of outcome in multivariate models. Change in the modified Roland back-specific functional status scale favored surgical treatment, and the relative benefit persisted over the follow-up period. Despite these differences, work and disability status at 10 years were comparable among those treated surgically or nonsurgically. Conclusions. Surgically treated patients with a herniated lumbar disc had more complete relief of leg pain and improved function and satisfaction compared with non-surgically treated patients over 10 years. Nevertheless, improvement in the patient's predominant symptom and work and disability outcomes were similar regardless of treatment received. For patients in whom elective discectomy is a treatment option, an individualized treatment plan requires patients and their physicians to integrate clinical findings with patient preferences based on their symptoms and goals.

Original languageEnglish (US)
Pages (from-to)927-935
Number of pages9
JournalSpine
Volume30
Issue number8
DOIs
StatePublished - Apr 15 2005
Externally publishedYes

Fingerprint

Sciatica
Spine
Leg
Physicians
Therapeutics
Pain
Diskectomy
Intervertebral Disc Displacement
Occupational Medicine
Patient Preference
Job Satisfaction
Back Pain
Low Back Pain

Keywords

  • Herniated lumbar disc
  • Lumbar disc surgery
  • Natural history
  • Outcome research
  • Prospective cohort study
  • Sciatica

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation : 10 Year results from the Maine lumbar spine study. / Atlas, Steven J.; Keller, Robert B.; Wu, Yen A.; Deyo, Richard (Rick); Singer, Daniel E.

In: Spine, Vol. 30, No. 8, 15.04.2005, p. 927-935.

Research output: Contribution to journalArticle

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abstract = "Study Design. A prospective cohort study. Objective. To assess 10-year outcomes of patients with sciatica resulting from a lumbar disc herniation treated surgically or nonsurgically. Summary of Background Data. There is little information comparing long-term outcomes of surgical and conservative therapy of lumbar disc herniation in contemporary clinical practice. Prior studies suggest that these outcomes are similar. Methods. Patients recruited from the practices of orthopedic surgeons, neurosurgeons, and occupational medicine physicians throughout Maine had baseline interviews with follow-up questionnaires mailed at regular intervals over 10 years. Clinical data were obtained at baseline from a physician questionnaire. Primary analyses were based on initial treatment received, either surgical or nonsurgical. Secondary analyses examined actual treatments received by 10 years. Outcomes included patient-reported symptoms of leg and back pain, functional status, satisfaction, and work and disability compensation status. Results. Of 507 eligible consenting patients initially enrolled, 10-year outcomes were available for 400 of 477 (84{\%}) surviving patients; 217 of 255 (85{\%}) treated surgically, and 183 of 222 (82{\%}) treated nonsurgically. Patients undergoing surgery had worse baseline symptoms and functional status than those initially treated nonsurgically. By 10 years, 25{\%} of surgical patients had undergone at least one additional lumbar spine operation, and 25{\%} of nonsurgical patients had at least one lumbar spine operation. At 10-year follow-up, 69{\%} of patients initially treated surgically reported improvement in their predominant symptom (back or leg pain) versus 61{\%} of those initially treated nonsurgically (P = 0.2). A larger proportion of surgical patients reported that their low back and leg pain were much better or completely gone (56{\%} vs. 40{\%}, P = 0.006) and were more satisfied with their current status (71{\%} vs. 56{\%}, P = 0.002). Treatment group differences persisted after adjustment for other determinants of outcome in multivariate models. Change in the modified Roland back-specific functional status scale favored surgical treatment, and the relative benefit persisted over the follow-up period. Despite these differences, work and disability status at 10 years were comparable among those treated surgically or nonsurgically. Conclusions. Surgically treated patients with a herniated lumbar disc had more complete relief of leg pain and improved function and satisfaction compared with non-surgically treated patients over 10 years. Nevertheless, improvement in the patient's predominant symptom and work and disability outcomes were similar regardless of treatment received. For patients in whom elective discectomy is a treatment option, an individualized treatment plan requires patients and their physicians to integrate clinical findings with patient preferences based on their symptoms and goals.",
keywords = "Herniated lumbar disc, Lumbar disc surgery, Natural history, Outcome research, Prospective cohort study, Sciatica",
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T2 - 10 Year results from the Maine lumbar spine study

AU - Atlas, Steven J.

AU - Keller, Robert B.

AU - Wu, Yen A.

AU - Deyo, Richard (Rick)

AU - Singer, Daniel E.

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N2 - Study Design. A prospective cohort study. Objective. To assess 10-year outcomes of patients with sciatica resulting from a lumbar disc herniation treated surgically or nonsurgically. Summary of Background Data. There is little information comparing long-term outcomes of surgical and conservative therapy of lumbar disc herniation in contemporary clinical practice. Prior studies suggest that these outcomes are similar. Methods. Patients recruited from the practices of orthopedic surgeons, neurosurgeons, and occupational medicine physicians throughout Maine had baseline interviews with follow-up questionnaires mailed at regular intervals over 10 years. Clinical data were obtained at baseline from a physician questionnaire. Primary analyses were based on initial treatment received, either surgical or nonsurgical. Secondary analyses examined actual treatments received by 10 years. Outcomes included patient-reported symptoms of leg and back pain, functional status, satisfaction, and work and disability compensation status. Results. Of 507 eligible consenting patients initially enrolled, 10-year outcomes were available for 400 of 477 (84%) surviving patients; 217 of 255 (85%) treated surgically, and 183 of 222 (82%) treated nonsurgically. Patients undergoing surgery had worse baseline symptoms and functional status than those initially treated nonsurgically. By 10 years, 25% of surgical patients had undergone at least one additional lumbar spine operation, and 25% of nonsurgical patients had at least one lumbar spine operation. At 10-year follow-up, 69% of patients initially treated surgically reported improvement in their predominant symptom (back or leg pain) versus 61% of those initially treated nonsurgically (P = 0.2). A larger proportion of surgical patients reported that their low back and leg pain were much better or completely gone (56% vs. 40%, P = 0.006) and were more satisfied with their current status (71% vs. 56%, P = 0.002). Treatment group differences persisted after adjustment for other determinants of outcome in multivariate models. Change in the modified Roland back-specific functional status scale favored surgical treatment, and the relative benefit persisted over the follow-up period. Despite these differences, work and disability status at 10 years were comparable among those treated surgically or nonsurgically. Conclusions. Surgically treated patients with a herniated lumbar disc had more complete relief of leg pain and improved function and satisfaction compared with non-surgically treated patients over 10 years. Nevertheless, improvement in the patient's predominant symptom and work and disability outcomes were similar regardless of treatment received. For patients in whom elective discectomy is a treatment option, an individualized treatment plan requires patients and their physicians to integrate clinical findings with patient preferences based on their symptoms and goals.

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KW - Herniated lumbar disc

KW - Lumbar disc surgery

KW - Natural history

KW - Outcome research

KW - Prospective cohort study

KW - Sciatica

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