title: Magnetic resonance imaging in follow-up assessment of sciatica.
abstract: BACKGROUND
  Magnetic resonance imaging (MRI) is frequently performed during follow-up in patients with known lumbar-disk herniation and persistent symptoms of sciatica. The association between findings on MRI and clinical outcome is controversial.
  
  
  METHODS
  We studied 283 patients in a randomized trial comparing surgery and prolonged conservative care for sciatica and lumbar-disk herniation. Patients underwent MRI at baseline and after 1 year. We used a 4-point scale to assess disk herniation on MRI, ranging from 1 for "definitely present" to 4 for "definitely absent." A favorable clinical outcome was defined as complete or nearly complete disappearance of symptoms at 1 year. We compared proportions of patients with a favorable outcome among those with a definite absence of disk herniation and those with a definite, probable, or possible presence of disk herniation at 1 year. The area under the receiver-operating-characteristic (ROC) curve was used to assess the prognostic accuracy of the 4-point scores regarding a favorable or unfavorable outcome, with 1 indicating perfect discriminatory value and 0.5 or less indicating no discriminatory value.
  
  
  RESULTS
  At 1 year, 84% of the patients reported having a favorable outcome. Disk herniation was visible in 35% with a favorable outcome and in 33% with an unfavorable outcome (P=0.70). A favorable outcome was reported in 85% of patients with disk herniation and 83% without disk herniation (P=0.70). MRI assessment of disk herniation did not distinguish between patients with a favorable outcome and those with an unfavorable outcome (area under ROC curve, 0.48).
  
  
  CONCLUSIONS
  MRI performed at 1-year follow-up in patients who had been treated for sciatica and lumbar-disk herniation did not distinguish between those with a favorable outcome and those with an unfavorable outcome. (Funded by the Netherlands Organization for Health Research and Development and the Hoelen Foundation; Controlled Clinical Trials number, ISRCTN26872154.).
authors.affiliation: Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Abdelilah
authors.initials: A
authors.lastname: el Barzouhi
authors.forename: Carmen L A M
authors.initials: CL
authors.lastname: Vleggeert-Lankamp
authors.forename: Geert J
authors.initials: GJ
authors.lastname: Lycklama à Nijeholt
authors.forename: Bas F
authors.initials: BF
authors.lastname: Van der Kallen
authors.forename: Wilbert B
authors.initials: WB
authors.lastname: van den Hout
authors.forename: Wilco C H
authors.initials: WC
authors.lastname: Jacobs
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.forename: Wilco C
authors.initials: WC
authors.lastname: Peul
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011379:Prognosis; D012372:ROC Curve; D012585:Sciatica / Q000209:etiology / Q000473:pathology* / Q000628:therapy