A pilot study on the recovery from paresis after lumbar disc herniation.
BACKGROUND
Although the existence of a motor defect in discogenic sciatica is a sign of severity, the literature does not provide evidence for an immediate requirement for surgery.


OBJECTIVE
To assess the course of sciatica with discogenic paresis and to determine possible prognostic factors for recovery or improvement.


METHODS
This open prospective multicenter study included patients with discogenic sciatica with paresis that had been developing for less than 1 month and was rated < or =3 on a 5-grade scale. Pain, the strength of 11 muscles, return to work, and analgesic intake were assessed at 1, 3, and 6 months. Recovery and improvement were defined by pain not exceeding 20 mm or < or =50% of the initial pain score and a score of either 5 (recovery) or 4 (improvement) for the weakest muscle at inclusion.


RESULTS
Sixty-seven patients were enrolled; 39 (58%) patients were treated surgically and 28 (42%) medically. Surgically treated patients differed from medically treated patients by a higher rate of extruded herniation, a higher number of paretic muscles (6.3 vs. 5; P = 0.051), and a longer course of sciatica (31.4 vs. 17.3 days; P = 0.034). At 6 months, 7 (10.4%) patients were lost to follow-up; 32 (53.3%) had improved, including 18 (30%) recovered, 33 (85%) back to work and having a professional activity, and 22 (39%) still taking analgesics. The only significant difference between recovered and not recovered patients was mean age at inclusion (43 vs. 51 years, P = 0.034). There were no significant differences between improved and not improved patients. Moreover, the outcome was not different in the two treatment groups: there were 17 (53%) improvements in surgically treated patients, including 8 (25%) recoveries, and 14 (56%) improvements in medically treated patients, including 8 (40%) recoveries.


CONCLUSIONS
This pilot study showed no difference between surgical or medical management for recovery or improvement in patients with discogenic paresis. These results need confirmation by a randomized study.
Service de Rhumatologie, CHU Pitié-Salpêtrière, Paris, France. genevieve.dubourg@psl.ap-hop-paris.fr
Genevieve
G
Dubourg
Sylvie
S
Rozenberg
Bruno
B
Fautrel
Isabelle
I
Valls-Bellec
Anne
A
Bissery
Thierry
T
Lang
Thierry
T
Faillot
Bernard
B
Duplan
Daniel
D
Briançon
Françoise
F
Levy-Weil
Gilles
G
Morlock
Jacques
J
Crouzet
Michel
M
Gatfosse
Christine
C
Bonnet
Eric
E
Houvenagel
Stéphane
S
Hary
Olivier
O
Brocq
Serge
S
Poiraudeau
Johann
J
Beaudreuil
Catherine
C
de Sauverzac
Stephanie
S
Durieux
Marc-Henri
MH
Levade
Philippe
P
Esposito
Daniel
D
Maitrot
Philippe
P
Goupille
Jean-Pierre
JP
Valat
Pierre
P
Bourgeois
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical; D017586:Diskectomy; D004358:Drug Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D010291:Paresis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012585:Sciatica / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome