Factors predicting the prognosis of lumbar radiculopathy due to disc herniation.
This study was designed to determine the prognostic factors in unilateral lumbar radiculopathy due to herniated nucleus pulposus (HNP); this was done by prospectively investigating the clinical course of consecutive patients with HNP. The study population consisted of 131 patients who complained primarily of unilateral leg pain, and who were examined by magnetic resonance imaging (MRI) to establish a definite diagnosis. Patients with a questionable diagnosis were excluded. The initial assessment was done within the first 2 months of presentation, according to conventional surgical indications. Surgery was performed only in patients who gave their informed consent for the procedure. Questionnaires were sent to patients twice, in 1994 and 1996, to assess the clinical outcome in those patients who did not meet the surgical indications and in those who met the indications, but who refused surgery. Clinical outcomes were classified into three categories based on the patients' own assessment. Fifty patients met the surgical indication criteria, and 25 were actually operated on. Neither these patients' profiles nor their MRI findings correlated with the results of the initial assessment. Patient age was significantly correlated with outcome only at the time of the first follow-up. The type of HNP and the result of the initial assessment were correlated with outcome at the times of both follow-ups, but the significance of these correlations had decreased at the second follow-up. In conclusion, initial assessment and type of HNP on MRI are major prognostic factors. However, the conventional manner of treatment selection is inadequate for the appropriate management of lumbar disc herniation.
Komori
Hiromich
H
Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
Okawa
Atsushi
A
Haro
Hirotaka
H
Shinomiya Ki
Ken-ichi
K
D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D011843:Radiculopathy / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D012307:Risk Factors; D012720:Severity of Illness Index; D013126:Spinal Nerve Roots / Q000503:physiopathology