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Prognostic value of magnetic resonance imaging findings in patients with sciatica

PainSci » bibliography » Barzouhi et al 2016
Tags: back pain, biomechanics, imaging, spine, pain problems, etiology, pro, diagnosis

One page on PainSci cites Barzouhi 2016: MRI and X-Ray Often Worse than Useless for Back Pain

PainSci commentary on Barzouhi 2016: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

It’s unclear whether anything that an MRI can see is useful in predicting how things are going to go for sciatica patients with herniated discs — and, therefore, whether they might benefit from surgery. This study confirmed that MRI is not useful in this way by following 283 cases, half who got surgery early, and the other half who only got surgery if it seemed necessary later. No important differences in these groups were detected: regardless of whether they got surgery early or not, only the original degree of nerve root compression and disc extrusion was associated with their outcomes … and only weakly. Disc herniation size was not associated with outcomes at all (in other words, big or small, herniations do not tell us anything about how a case of sciatica will work out).

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: This study aimed to determine the prognostic value of MRI variables to predict outcome in patients with herniated disc-related sciatica, and whether MRI could facilitate the decision making between early surgery and prolonged conservative care in these patients.

METHODS: A prospective observational evaluation of patients enrolled in a randomized trial with 1-year follow-up was completed. A total of 283 patients with sciatica who had a radiologically confirmed disc herniation were randomized either to surgery or to prolonged conservative care with surgery if needed. Outcome measures were recovery and leg pain severity. Recovery was registered on a 7-point Likert scale. Complete/near complete recovery was considered a satisfactory outcome. Leg pain severity was measured on a 0- to 100-mm visual analog scale. Multiple MRI characteristics of the degenerated disc herniation were independently scored by 3 spine experts. Cox models were used to study the influence of MRI variables on rate of recovery, and linear mixed models were used to determine the predictive value of MRI variables for leg pain severity during follow-up. The interaction of each MRI predictor with treatment allocation was tested. There were no study-specific conflicts of interest.

RESULTS: Baseline MRI variables associated with less leg pain severity were the reader's assessment of presence of nerve root compression (p < 0.001), and assessment of extrusion compared with protrusion of the disc herniation (p = 0.006). Both variables tended to be associated, but not significantly, with satisfactory outcome during follow-up (HR 1.45, 95% CI 0.93-2.24, and HR 1.24, 95% CI 0.96-1.61, respectively). The size of disc herniation at baseline was not associated with outcome. There was no significant change in the effects between treatment groups.

CONCLUSIONS: MRI assessment of the presence of nerve root compression and extrusion of a herniated disc at baseline was associated with less leg pain during 1-year follow-up, irrespective of a surgical or conservative treatment. MRI findings seem not to be helpful in determining which patients might fare better with early surgery compared with a strategy of prolonged conservative care. Clinical trial registration no.: ISRCTN26872154 ( ).

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