title: Predictors of patient-reported recovery from motor or sensory deficits two years after acute symptomatic lumbar disk herniation.
abstract: OBJECTIVE
  To determine the prevalence of patient-reported recovery from motor or sensory deficits over 2 years of follow-up after acute symptomatic lumbar disk herniation and to identify predictors of perceived recovery.
  
  
  METHODS
  A prospective inception cohort.
  
  
  METHODS
  An outpatient spine clinic.
  
  
  METHODS
  Consecutive adults with lumbosacral radicular syndrome (onset ≤12 weeks) due to symptomatic lumbar disk herniation, confirmed by magnetic resonance imaging: 95 patients with a baseline motor deficit by physical examination and 59 patients with a baseline sensory deficit by physical examination.
  
  
  METHODS
  The patients received individualized nonsurgical treatment or, in a minority of cases, surgical treatment. All of the patients underwent a standardized baseline neurologic examination, including motor and sensory testing. Patients with a motor or sensory deficit at the baseline examination reported on whether they perceived persisting weakness or sensory deficits at 1- and 2-year follow-up. We calculated the 1- and 2-year prevalence of patient-reported persisting weakness or sensory deficits. We examined factors associated with perceived recovery from motor or sensory deficits by using bivariate analyses and multivariate logistic regression.
  
  
  RESULTS
  Among patients with a baseline motor deficit, the prevalence of patient-reported continuing weakness was 38% at 1 year and 25% at 2 years. Among patients with a baseline sensory deficit, the prevalence of patient-reported continuing sensory deficits was 53% at 1 year and 47% at 2 years. A positive straight leg raise test (odds ratio [OR] 0.26 [95% confidence interval (CI) 0.08-0.83]) and opioid use (OR 0.24 [95% CI 0.06-0.83]) were independently and negatively predictive of patient-reported motor recovery. Female gender was independently and negatively predictive of patient-reported sensory recovery (OR 0.20 [95% CI 0.04-0.99]).
  
  
  CONCLUSIONS
  Patient-reported recovery from motor deficits after lumbar disk herniation occurs for 75% of patients over 2 years, but recovery from sensory deficits over this time frame occurs in only 53% of patients. A positive straight-leg raise test and female gender may predict poor recovery from motor and sensory deficits, respectively.
authors.affiliation: Division of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA, USA. pradeep.suri@va.gov
authors.forename: Pradeep
authors.initials: P
authors.lastname: Suri
authors.forename: James
authors.initials: J
authors.lastname: Rainville
authors.forename: Alfred
authors.initials: A
authors.lastname: Gellhorn
mesh_terms: D000208:Acute Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D011446:Prospective Studies; D020127:Recovery of Function; D012585:Sciatica / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D012677:Sensation / Q000502:physiology*; D013126:Spinal Nerve Roots / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D013997:Time Factors