Prognostic Factors for Persistent Leg-Pain in Patients Hospitalized with Acute Sciatica

Abstract

Study Design. Prospective cohort study. Objective. To identify potential prognostic factors for persistent leg-pain at 12 months among patients hospitalized with acute severe sciatica. Summary of Background Data. The long-term outcome for patients admitted to hospital with sciatica is generally unfavorable. Results concerning prognostic factors for persistent sciatica are limited and conflicting. Methods. A total of 210 patients acutely admitted to hospital for either surgical or nonsurgical treatment of sciatica were consecutively recruited and received a thorough clinical and radiographic examination in addition to responding to a comprehensive questionnaire. Follow-up assessments were done at 6 weeks, 6 months, and 12 months. Potential prognostic factors were measured at baseline and at 6 weeks. The impact of these factors on leg-pain was analyzed by multiple linear regression modeling. Results. A total of 151 patients completed the entire study, 93 receiving nonrandomized surgical treatment. The final multivariate models showed that the following factors were significantly associated with leg-pain at 12 months: high psychosocial risk according to the O¨ rebro Musculosceletal Pain Questionnaire (unstandardized beta coefficient 1.55, 95% confidence interval [CI] 0.72–2.38, P < 0.001), not receiving surgical treatment (1.11, 95% CI 0.29–1.93, P ¼ 0.01), not actively employed upon admission (1.47, 95% CI 0.63–2.31, P < 0.01), and self-reported leg-pain recorded 6 weeks posthospital admission (0.49, 95% CI 0.34–0.63, P < 0.001). Interaction analysis showed that the O¨ rebro Musculosceletal Pain Questionnaire had significant prognostic value only on the nonsurgically treated patients (3.26, 95% CI 1.89–4.63, P < 0.001). Conclusion. The results suggest that a psychosocial screening tool and the implementation of a 6-week postadmission followup has prognostic value in the hospital management of severe sciatica.