The Maine Lumbar Spine Study, part II

1-Year outcomes of surgical and nonsurgical management of sciatica

Steven J. Atlas, Richard (Rick) Deyo, Robert B. Keller, Alice M. Chapin, Donald L. Patrick, John M. Long, Daniel E. Singer

Research output: Contribution to journalArticle

249 Citations (Scopus)

Abstract

Study Design. The Maine Lumbar Spine Study is a prospective cohort study of patients recruited from the practices of orthopedic surgeons, neurosurgeons, and occupational medicine physicians throughout Maine. Objective. To assess 1-year outcomes of patients with sciatica believed to be due to a herniated lumbar disc treated surgically or nonsurgically. Summary of Background Data. Lumbar spine surgery rates vary by geographic region and may reflect uncertainty about optimal clinical use. Methods. Eligible consenting patients participated in a baseline interview performed by study personnel and then were mailed follow-up questionnaires at 3, 6, and 12 months. Clinical data were obtained from a physician questionnaire. Outcomes included patient-reported symptoms of leg and back pain, functional status, disability, quality of life, and satisfaction with care. Results. Five hundred seven patients with sciatica, 275 treated surgically and 232 treated nonsurgically initially, were enrolled. Surgically treated patients, on average, had more severe symptoms and had more severe physical and imaging findings than nonsurgically treated patients at entry. Although few surgically treated patients had mild symptoms and few nonsurgically treated patients had severe symptoms, about half in each treatment group had symptoms that fell into a moderate category. At the 1-year evaluation, improvement in symptoms, functional status, and disability were found in both treatment groups. However, surgically treated patients reported significantly greater improvement. For the predominant symptom, either back or leg pain, 71% of surgically treated and 43% of nonsurgically treated patients reported definite improvement (P <0.001). This effect was even greater after adjustment for differences between treatment groups at entry (relative odds of definite improvement. 4.3; P <0.001). For patients with moderate symptoms and abnormal physical examination findings, surgical treatment also resulted in greater improvement than nonsurgical treatment. However, there was little difference in the employment or workers' compensation status of patients treated surgically versus nonsurgically (5% vs. 7% unemployed at 1-year follow-up if employed at entry [P= 0.68]; 46% vs. 55% receiving workers' compensation at 1-year follow-up if receiving it at entry [P = 0.30] for surgical and nonsurgical management, respectively). For patients with mild symptoms, the benefits of surgical and nonsurgical treatment were similar. Conclusions. Although surgically treated patients were on average more symptomatic at entry, there was substantial overlap in symptoms between surgically treated and nonsurgically treated patients. Surgically treated patients with sciatica reported substantially greater improvement at 1-year follow-up. However, employment and compensation outcomes were similar between the two treatment groups, and surgery appeared to provide little advantage for the subset of patients with mild symptoms. These results should be interpreted cautiously, because surgical treatment was not assigned randomly. Long-term follow-up will determine if these differences persist.

Original languageEnglish (US)
Pages (from-to)1777-1786
Number of pages10
JournalSpine
Volume21
Issue number15
DOIs
StatePublished - Aug 1 1996
Externally publishedYes

Fingerprint

Sciatica
Spine
Workers' Compensation
Therapeutics
Leg
Physicians
Intervertebral Disc Displacement
Occupational Medicine

Keywords

  • cohort study
  • lumbar disc surgery
  • natural history
  • outcomes research
  • sciatica

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Atlas, S. J., Deyo, R. R., Keller, R. B., Chapin, A. M., Patrick, D. L., Long, J. M., & Singer, D. E. (1996). The Maine Lumbar Spine Study, part II: 1-Year outcomes of surgical and nonsurgical management of sciatica. Spine, 21(15), 1777-1786. https://doi.org/10.1097/00007632-199608010-00011

The Maine Lumbar Spine Study, part II : 1-Year outcomes of surgical and nonsurgical management of sciatica. / Atlas, Steven J.; Deyo, Richard (Rick); Keller, Robert B.; Chapin, Alice M.; Patrick, Donald L.; Long, John M.; Singer, Daniel E.

In: Spine, Vol. 21, No. 15, 01.08.1996, p. 1777-1786.

Research output: Contribution to journalArticle

Atlas, SJ, Deyo, RR, Keller, RB, Chapin, AM, Patrick, DL, Long, JM & Singer, DE 1996, 'The Maine Lumbar Spine Study, part II: 1-Year outcomes of surgical and nonsurgical management of sciatica', Spine, vol. 21, no. 15, pp. 1777-1786. https://doi.org/10.1097/00007632-199608010-00011
Atlas, Steven J. ; Deyo, Richard (Rick) ; Keller, Robert B. ; Chapin, Alice M. ; Patrick, Donald L. ; Long, John M. ; Singer, Daniel E. / The Maine Lumbar Spine Study, part II : 1-Year outcomes of surgical and nonsurgical management of sciatica. In: Spine. 1996 ; Vol. 21, No. 15. pp. 1777-1786.
@article{351be2bf9ed445f9b65b0fb0a19b1849,
title = "The Maine Lumbar Spine Study, part II: 1-Year outcomes of surgical and nonsurgical management of sciatica",
abstract = "Study Design. The Maine Lumbar Spine Study is a prospective cohort study of patients recruited from the practices of orthopedic surgeons, neurosurgeons, and occupational medicine physicians throughout Maine. Objective. To assess 1-year outcomes of patients with sciatica believed to be due to a herniated lumbar disc treated surgically or nonsurgically. Summary of Background Data. Lumbar spine surgery rates vary by geographic region and may reflect uncertainty about optimal clinical use. Methods. Eligible consenting patients participated in a baseline interview performed by study personnel and then were mailed follow-up questionnaires at 3, 6, and 12 months. Clinical data were obtained from a physician questionnaire. Outcomes included patient-reported symptoms of leg and back pain, functional status, disability, quality of life, and satisfaction with care. Results. Five hundred seven patients with sciatica, 275 treated surgically and 232 treated nonsurgically initially, were enrolled. Surgically treated patients, on average, had more severe symptoms and had more severe physical and imaging findings than nonsurgically treated patients at entry. Although few surgically treated patients had mild symptoms and few nonsurgically treated patients had severe symptoms, about half in each treatment group had symptoms that fell into a moderate category. At the 1-year evaluation, improvement in symptoms, functional status, and disability were found in both treatment groups. However, surgically treated patients reported significantly greater improvement. For the predominant symptom, either back or leg pain, 71{\%} of surgically treated and 43{\%} of nonsurgically treated patients reported definite improvement (P <0.001). This effect was even greater after adjustment for differences between treatment groups at entry (relative odds of definite improvement. 4.3; P <0.001). For patients with moderate symptoms and abnormal physical examination findings, surgical treatment also resulted in greater improvement than nonsurgical treatment. However, there was little difference in the employment or workers' compensation status of patients treated surgically versus nonsurgically (5{\%} vs. 7{\%} unemployed at 1-year follow-up if employed at entry [P= 0.68]; 46{\%} vs. 55{\%} receiving workers' compensation at 1-year follow-up if receiving it at entry [P = 0.30] for surgical and nonsurgical management, respectively). For patients with mild symptoms, the benefits of surgical and nonsurgical treatment were similar. Conclusions. Although surgically treated patients were on average more symptomatic at entry, there was substantial overlap in symptoms between surgically treated and nonsurgically treated patients. Surgically treated patients with sciatica reported substantially greater improvement at 1-year follow-up. However, employment and compensation outcomes were similar between the two treatment groups, and surgery appeared to provide little advantage for the subset of patients with mild symptoms. These results should be interpreted cautiously, because surgical treatment was not assigned randomly. Long-term follow-up will determine if these differences persist.",
keywords = "cohort study, lumbar disc surgery, natural history, outcomes research, sciatica",
author = "Atlas, {Steven J.} and Deyo, {Richard (Rick)} and Keller, {Robert B.} and Chapin, {Alice M.} and Patrick, {Donald L.} and Long, {John M.} and Singer, {Daniel E.}",
year = "1996",
month = "8",
day = "1",
doi = "10.1097/00007632-199608010-00011",
language = "English (US)",
volume = "21",
pages = "1777--1786",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "15",

}

TY - JOUR

T1 - The Maine Lumbar Spine Study, part II

T2 - 1-Year outcomes of surgical and nonsurgical management of sciatica

AU - Atlas, Steven J.

AU - Deyo, Richard (Rick)

AU - Keller, Robert B.

AU - Chapin, Alice M.

AU - Patrick, Donald L.

AU - Long, John M.

AU - Singer, Daniel E.

PY - 1996/8/1

Y1 - 1996/8/1

N2 - Study Design. The Maine Lumbar Spine Study is a prospective cohort study of patients recruited from the practices of orthopedic surgeons, neurosurgeons, and occupational medicine physicians throughout Maine. Objective. To assess 1-year outcomes of patients with sciatica believed to be due to a herniated lumbar disc treated surgically or nonsurgically. Summary of Background Data. Lumbar spine surgery rates vary by geographic region and may reflect uncertainty about optimal clinical use. Methods. Eligible consenting patients participated in a baseline interview performed by study personnel and then were mailed follow-up questionnaires at 3, 6, and 12 months. Clinical data were obtained from a physician questionnaire. Outcomes included patient-reported symptoms of leg and back pain, functional status, disability, quality of life, and satisfaction with care. Results. Five hundred seven patients with sciatica, 275 treated surgically and 232 treated nonsurgically initially, were enrolled. Surgically treated patients, on average, had more severe symptoms and had more severe physical and imaging findings than nonsurgically treated patients at entry. Although few surgically treated patients had mild symptoms and few nonsurgically treated patients had severe symptoms, about half in each treatment group had symptoms that fell into a moderate category. At the 1-year evaluation, improvement in symptoms, functional status, and disability were found in both treatment groups. However, surgically treated patients reported significantly greater improvement. For the predominant symptom, either back or leg pain, 71% of surgically treated and 43% of nonsurgically treated patients reported definite improvement (P <0.001). This effect was even greater after adjustment for differences between treatment groups at entry (relative odds of definite improvement. 4.3; P <0.001). For patients with moderate symptoms and abnormal physical examination findings, surgical treatment also resulted in greater improvement than nonsurgical treatment. However, there was little difference in the employment or workers' compensation status of patients treated surgically versus nonsurgically (5% vs. 7% unemployed at 1-year follow-up if employed at entry [P= 0.68]; 46% vs. 55% receiving workers' compensation at 1-year follow-up if receiving it at entry [P = 0.30] for surgical and nonsurgical management, respectively). For patients with mild symptoms, the benefits of surgical and nonsurgical treatment were similar. Conclusions. Although surgically treated patients were on average more symptomatic at entry, there was substantial overlap in symptoms between surgically treated and nonsurgically treated patients. Surgically treated patients with sciatica reported substantially greater improvement at 1-year follow-up. However, employment and compensation outcomes were similar between the two treatment groups, and surgery appeared to provide little advantage for the subset of patients with mild symptoms. These results should be interpreted cautiously, because surgical treatment was not assigned randomly. Long-term follow-up will determine if these differences persist.

AB - Study Design. The Maine Lumbar Spine Study is a prospective cohort study of patients recruited from the practices of orthopedic surgeons, neurosurgeons, and occupational medicine physicians throughout Maine. Objective. To assess 1-year outcomes of patients with sciatica believed to be due to a herniated lumbar disc treated surgically or nonsurgically. Summary of Background Data. Lumbar spine surgery rates vary by geographic region and may reflect uncertainty about optimal clinical use. Methods. Eligible consenting patients participated in a baseline interview performed by study personnel and then were mailed follow-up questionnaires at 3, 6, and 12 months. Clinical data were obtained from a physician questionnaire. Outcomes included patient-reported symptoms of leg and back pain, functional status, disability, quality of life, and satisfaction with care. Results. Five hundred seven patients with sciatica, 275 treated surgically and 232 treated nonsurgically initially, were enrolled. Surgically treated patients, on average, had more severe symptoms and had more severe physical and imaging findings than nonsurgically treated patients at entry. Although few surgically treated patients had mild symptoms and few nonsurgically treated patients had severe symptoms, about half in each treatment group had symptoms that fell into a moderate category. At the 1-year evaluation, improvement in symptoms, functional status, and disability were found in both treatment groups. However, surgically treated patients reported significantly greater improvement. For the predominant symptom, either back or leg pain, 71% of surgically treated and 43% of nonsurgically treated patients reported definite improvement (P <0.001). This effect was even greater after adjustment for differences between treatment groups at entry (relative odds of definite improvement. 4.3; P <0.001). For patients with moderate symptoms and abnormal physical examination findings, surgical treatment also resulted in greater improvement than nonsurgical treatment. However, there was little difference in the employment or workers' compensation status of patients treated surgically versus nonsurgically (5% vs. 7% unemployed at 1-year follow-up if employed at entry [P= 0.68]; 46% vs. 55% receiving workers' compensation at 1-year follow-up if receiving it at entry [P = 0.30] for surgical and nonsurgical management, respectively). For patients with mild symptoms, the benefits of surgical and nonsurgical treatment were similar. Conclusions. Although surgically treated patients were on average more symptomatic at entry, there was substantial overlap in symptoms between surgically treated and nonsurgically treated patients. Surgically treated patients with sciatica reported substantially greater improvement at 1-year follow-up. However, employment and compensation outcomes were similar between the two treatment groups, and surgery appeared to provide little advantage for the subset of patients with mild symptoms. These results should be interpreted cautiously, because surgical treatment was not assigned randomly. Long-term follow-up will determine if these differences persist.

KW - cohort study

KW - lumbar disc surgery

KW - natural history

KW - outcomes research

KW - sciatica

UR - http://www.scopus.com/inward/record.url?scp=0029662160&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029662160&partnerID=8YFLogxK

U2 - 10.1097/00007632-199608010-00011

DO - 10.1097/00007632-199608010-00011

M3 - Article

VL - 21

SP - 1777

EP - 1786

JO - Spine

JF - Spine

SN - 0362-2436

IS - 15

ER -