Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: Five-Year outcomes from the maine lumbar spine study

Steven J. Atlas, Robert B. Keller, YuChiao Chang, Richard (Rick) Deyo, Daniel E. Singer

Research output: Contribution to journalArticle

181 Citations (Scopus)

Abstract

Study Design. A prospective cohort study. Objective, To assess 5-year outcomes for patients with sciatica caused by a lumbar disc herniation treated surgically or nonsurgically. Summary of Background Data. There is limited knowledge about long-term treatment outcomes of sciatica caused by a lumbar disc herniation, particularly the relative benefits of surgical and conservative therapy in contemporary clinical practice. Methods. Eligible, consenting patients recruited from the practices of orthopedic surgeons, neurosurgeons, and occupational medicine physicians throughout Maine had baseline interviews with mailed follow-up questionnaires at 3, 6, and 12 months and annually thereafter. Clinical data were obtained at baseline from a physician questionnaire. Outcomes included patient-reported symptoms of leg and back pain, functional status, satisfaction, and employment and compensation status. Results. Of 507 patients initially enrolled, 5-year outcomes were available for 402 (79.3%) patients: 220 (80%) treated surgically and 182 (78.4%) treated nonsurgically. Surgically treated patients had worse baseline symptoms and functional status than those initially treated nonsurgically. By 5 years 19% of surgical patients had undergone at least one additional lumbar spine operation, and 16% of nonsurgical patients had opted for at least one lumbar spine operation. Overall, patients treated initially with surgery reported better outcomes. At the 5-year follow-up, 70% of patients initially treated surgically reported improvement in their predominant symptom (back or leg pain) versus 56% of those initially treated nonsurgically (P <0.001). Similarly, a larger proportion of surgical patients reported satisfaction with their current status (63% vs. 46%, P<0.001). These differences persisted after adjustment for other determinants of outcome. The relative advantage of surgery was greatest early in follow-up and narrowed over 5 years. There was no difference in the proportion of patients receiving disability compensation at the 5-year follow-up. The least symptomatic patients at baseline did well regardless of initial treatment, although function improved more in the surgical group. Conclusions. For patients with moderate or severe sciatica, surgical treatment was associated with greater improvement than nonsurgical treatment at 5 years. However, patients treated surgically were as likely to be receiving disability compensation, and the relative benefit of surgery decreased over time.

Original languageEnglish (US)
Pages (from-to)1179-1187
Number of pages9
JournalSpine
Volume26
Issue number10
DOIs
StatePublished - May 15 2001
Externally publishedYes

Fingerprint

Sciatica
Spine
Leg
Physicians
Occupational Medicine
Back Pain
Patient Satisfaction

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

Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation : Five-Year outcomes from the maine lumbar spine study. / Atlas, Steven J.; Keller, Robert B.; Chang, YuChiao; Deyo, Richard (Rick); Singer, Daniel E.

In: Spine, Vol. 26, No. 10, 15.05.2001, p. 1179-1187.

Research output: Contribution to journalArticle

Atlas, Steven J. ; Keller, Robert B. ; Chang, YuChiao ; Deyo, Richard (Rick) ; Singer, Daniel E. / Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation : Five-Year outcomes from the maine lumbar spine study. In: Spine. 2001 ; Vol. 26, No. 10. pp. 1179-1187.
@article{5344fc43c06b4cf1a2fb70ba6d3c4748,
title = "Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: Five-Year outcomes from the maine lumbar spine study",
abstract = "Study Design. A prospective cohort study. Objective, To assess 5-year outcomes for patients with sciatica caused by a lumbar disc herniation treated surgically or nonsurgically. Summary of Background Data. There is limited knowledge about long-term treatment outcomes of sciatica caused by a lumbar disc herniation, particularly the relative benefits of surgical and conservative therapy in contemporary clinical practice. Methods. Eligible, consenting patients recruited from the practices of orthopedic surgeons, neurosurgeons, and occupational medicine physicians throughout Maine had baseline interviews with mailed follow-up questionnaires at 3, 6, and 12 months and annually thereafter. Clinical data were obtained at baseline from a physician questionnaire. Outcomes included patient-reported symptoms of leg and back pain, functional status, satisfaction, and employment and compensation status. Results. Of 507 patients initially enrolled, 5-year outcomes were available for 402 (79.3{\%}) patients: 220 (80{\%}) treated surgically and 182 (78.4{\%}) treated nonsurgically. Surgically treated patients had worse baseline symptoms and functional status than those initially treated nonsurgically. By 5 years 19{\%} of surgical patients had undergone at least one additional lumbar spine operation, and 16{\%} of nonsurgical patients had opted for at least one lumbar spine operation. Overall, patients treated initially with surgery reported better outcomes. At the 5-year follow-up, 70{\%} of patients initially treated surgically reported improvement in their predominant symptom (back or leg pain) versus 56{\%} of those initially treated nonsurgically (P <0.001). Similarly, a larger proportion of surgical patients reported satisfaction with their current status (63{\%} vs. 46{\%}, P<0.001). These differences persisted after adjustment for other determinants of outcome. The relative advantage of surgery was greatest early in follow-up and narrowed over 5 years. There was no difference in the proportion of patients receiving disability compensation at the 5-year follow-up. The least symptomatic patients at baseline did well regardless of initial treatment, although function improved more in the surgical group. Conclusions. For patients with moderate or severe sciatica, surgical treatment was associated with greater improvement than nonsurgical treatment at 5 years. However, patients treated surgically were as likely to be receiving disability compensation, and the relative benefit of surgery decreased over time.",
keywords = "Herniated lumbar disc, Lumbar disc surgery, Natural history, Outcome research, Prospective cohort study, Sciatica",
author = "Atlas, {Steven J.} and Keller, {Robert B.} and YuChiao Chang and Deyo, {Richard (Rick)} and Singer, {Daniel E.}",
year = "2001",
month = "5",
day = "15",
doi = "10.1097/00007632-200105150-00017",
language = "English (US)",
volume = "26",
pages = "1179--1187",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation

T2 - Five-Year outcomes from the maine lumbar spine study

AU - Atlas, Steven J.

AU - Keller, Robert B.

AU - Chang, YuChiao

AU - Deyo, Richard (Rick)

AU - Singer, Daniel E.

PY - 2001/5/15

Y1 - 2001/5/15

N2 - Study Design. A prospective cohort study. Objective, To assess 5-year outcomes for patients with sciatica caused by a lumbar disc herniation treated surgically or nonsurgically. Summary of Background Data. There is limited knowledge about long-term treatment outcomes of sciatica caused by a lumbar disc herniation, particularly the relative benefits of surgical and conservative therapy in contemporary clinical practice. Methods. Eligible, consenting patients recruited from the practices of orthopedic surgeons, neurosurgeons, and occupational medicine physicians throughout Maine had baseline interviews with mailed follow-up questionnaires at 3, 6, and 12 months and annually thereafter. Clinical data were obtained at baseline from a physician questionnaire. Outcomes included patient-reported symptoms of leg and back pain, functional status, satisfaction, and employment and compensation status. Results. Of 507 patients initially enrolled, 5-year outcomes were available for 402 (79.3%) patients: 220 (80%) treated surgically and 182 (78.4%) treated nonsurgically. Surgically treated patients had worse baseline symptoms and functional status than those initially treated nonsurgically. By 5 years 19% of surgical patients had undergone at least one additional lumbar spine operation, and 16% of nonsurgical patients had opted for at least one lumbar spine operation. Overall, patients treated initially with surgery reported better outcomes. At the 5-year follow-up, 70% of patients initially treated surgically reported improvement in their predominant symptom (back or leg pain) versus 56% of those initially treated nonsurgically (P <0.001). Similarly, a larger proportion of surgical patients reported satisfaction with their current status (63% vs. 46%, P<0.001). These differences persisted after adjustment for other determinants of outcome. The relative advantage of surgery was greatest early in follow-up and narrowed over 5 years. There was no difference in the proportion of patients receiving disability compensation at the 5-year follow-up. The least symptomatic patients at baseline did well regardless of initial treatment, although function improved more in the surgical group. Conclusions. For patients with moderate or severe sciatica, surgical treatment was associated with greater improvement than nonsurgical treatment at 5 years. However, patients treated surgically were as likely to be receiving disability compensation, and the relative benefit of surgery decreased over time.

AB - Study Design. A prospective cohort study. Objective, To assess 5-year outcomes for patients with sciatica caused by a lumbar disc herniation treated surgically or nonsurgically. Summary of Background Data. There is limited knowledge about long-term treatment outcomes of sciatica caused by a lumbar disc herniation, particularly the relative benefits of surgical and conservative therapy in contemporary clinical practice. Methods. Eligible, consenting patients recruited from the practices of orthopedic surgeons, neurosurgeons, and occupational medicine physicians throughout Maine had baseline interviews with mailed follow-up questionnaires at 3, 6, and 12 months and annually thereafter. Clinical data were obtained at baseline from a physician questionnaire. Outcomes included patient-reported symptoms of leg and back pain, functional status, satisfaction, and employment and compensation status. Results. Of 507 patients initially enrolled, 5-year outcomes were available for 402 (79.3%) patients: 220 (80%) treated surgically and 182 (78.4%) treated nonsurgically. Surgically treated patients had worse baseline symptoms and functional status than those initially treated nonsurgically. By 5 years 19% of surgical patients had undergone at least one additional lumbar spine operation, and 16% of nonsurgical patients had opted for at least one lumbar spine operation. Overall, patients treated initially with surgery reported better outcomes. At the 5-year follow-up, 70% of patients initially treated surgically reported improvement in their predominant symptom (back or leg pain) versus 56% of those initially treated nonsurgically (P <0.001). Similarly, a larger proportion of surgical patients reported satisfaction with their current status (63% vs. 46%, P<0.001). These differences persisted after adjustment for other determinants of outcome. The relative advantage of surgery was greatest early in follow-up and narrowed over 5 years. There was no difference in the proportion of patients receiving disability compensation at the 5-year follow-up. The least symptomatic patients at baseline did well regardless of initial treatment, although function improved more in the surgical group. Conclusions. For patients with moderate or severe sciatica, surgical treatment was associated with greater improvement than nonsurgical treatment at 5 years. However, patients treated surgically were as likely to be receiving disability compensation, and the relative benefit of surgery decreased over time.

KW - Herniated lumbar disc

KW - Lumbar disc surgery

KW - Natural history

KW - Outcome research

KW - Prospective cohort study

KW - Sciatica

UR - http://www.scopus.com/inward/record.url?scp=0035873306&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035873306&partnerID=8YFLogxK

U2 - 10.1097/00007632-200105150-00017

DO - 10.1097/00007632-200105150-00017

M3 - Article

C2 - 11413434

AN - SCOPUS:0035873306

VL - 26

SP - 1179

EP - 1187

JO - Spine

JF - Spine

SN - 0362-2436

IS - 10

ER -