title: Influence of low back pain and prognostic value of MRI in sciatica patients in relation to back pain.
abstract: BACKGROUND
  Patients with sciatica frequently complain about associated back pain. It is not known whether there are prognostic relevant differences in Magnetic Resonance Imaging (MRI) findings between sciatica patients with and without disabling back pain.
  
  
  METHODS
  The study population contained patients with sciatica who underwent a baseline MRI to assess eligibility for a randomized trial designed to compare the efficacy of early surgery with prolonged conservative care for sciatica. Two neuroradiologists and one neurosurgeon independently evaluated all MR images. The MRI readers were blinded to symptom status. The MRI findings were compared between sciatica patients with and without disabling back pain. The presence of disabling back pain at baseline was correlated with perceived recovery at one year.
  
  
  RESULTS
  Of 379 included sciatica patients, 158 (42%) had disabling back pain. Of the patients with both sciatica and disabling back pain 68% did reveal a herniated disc with nerve root compression on MRI, compared to 88% of patients with predominantly sciatica (P<0.001). The existence of disabling back pain in sciatica at baseline was negatively associated with perceived recovery at one year (Odds ratio [OR] 0.32, 95% Confidence Interval 0.18-0.56, P<0.001). Sciatica patients with disabling back pain in absence of nerve root compression on MRI at baseline reported less perceived recovery at one year compared to those with predominantly sciatica and nerve root compression on MRI (50% vs 91%, P<0.001).
  
  
  CONCLUSIONS
  Sciatica patients with disabling low back pain reported an unfavorable outcome at one-year follow-up compared to those with predominantly sciatica. If additionally a clear herniated disc with nerve root compression on MRI was absent, the results were even worse.
authors.affiliation: Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Abdelilah
authors.initials: A
authors.lastname: el Barzouhi
authors.affiliation: Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Carmen L A M
authors.initials: CL
authors.lastname: Vleggeert-Lankamp
authors.affiliation: Department of Radiology, Medical Center Haaglanden, the Hague, the Netherlands.
authors.forename: Geert J
authors.initials: GJ
authors.lastname: Lycklama à Nijeholt
authors.affiliation: Department of Radiology, Medical Center Haaglanden, the Hague, the Netherlands.
authors.forename: Bas F
authors.initials: BF
authors.lastname: Van der Kallen
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Wilbert B
authors.initials: WB
authors.lastname: van den Hout
authors.affiliation: Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.affiliation: Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Neurosurgery, Medical Center Haaglanden, the Hague, the Netherlands.
authors.forename: Wilco C
authors.initials: WC
authors.lastname: Peul
mesh_terms: D000328:Adult; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000150:complications* / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012585:Sciatica / Q000150:complications* / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome