Skip to main content
NCBI home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 2002 Feb;52(475):119–123.

Predicting the outcome of sciatica at short-term follow-up.

Patrick C A J Vroomen 1, M C T F M de Krom 1, J A Knottnerus 1
PMCID: PMC1314232  PMID: 11887877

Abstract

BACKGROUND: The prognostic value of the clinical findings elicited in the patient presenting with sciatica is unknown. AIM: To investigate whether history and physical examination findings can predict outcome. DESIGN OF STUDY: Prospective study of prognostic factors. SETTING: A sample of primary care patients with sciatica. METHOD: Short-term favourable outcome was registered as improvement perceived by the patient after two weeks. Long-term failure was defined as eventual surgery or lack of improvement after three months. RESULTS: The signs and symptoms that most consistently predicted an unfavourable outcome were: a disease duration of more than 30 days; increased pain on sitting; and more pain on coughing, sneezing or straining. The straight leg raising test and, to a lesser degree the reversed straight leg raising test, were the most consistent examination findings associated with poor outcome. Chances of short-term improvement were also related to the body weight relative to the length. CONCLUSION: The predictors in this study can indicate the prognosis of patients with sciatica at an early stage. Knowledge of these prognostic factors may help to fine tune treatment decisions and improve patient selection in trials of conservative therapy strategies.

Full Text

The Full Text of this article is available as a PDF (72.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barrios C., Ahmed M., Arrotegui J. I., Björnsson A. Clinical factors predicting outcome after surgery for herniated lumbar disc: an epidemiological multivariate analysis. J Spinal Disord. 1990 Sep;3(3):205–209. [PubMed] [Google Scholar]
  2. Carragee E. J., Kim D. H. A prospective analysis of magnetic resonance imaging findings in patients with sciatica and lumbar disc herniation. Correlation of outcomes with disc fragment and canal morphology. Spine (Phila Pa 1976) 1997 Jul 15;22(14):1650–1660. doi: 10.1097/00007632-199707150-00025. [DOI] [PubMed] [Google Scholar]
  3. Deyo R. A. Comparative validity of the sickness impact profile and shorter scales for functional assessment in low-back pain. Spine (Phila Pa 1976) 1986 Nov;11(9):951–954. doi: 10.1097/00007632-198611000-00017. [DOI] [PubMed] [Google Scholar]
  4. Herron L. D., Turner J., Clancy S., Weiner P. The differential utility of the Minnesota Multiphasic Personality Inventory. A predictor of outcome in lumbar laminectomy for disc herniation versus spinal stenosis. Spine (Phila Pa 1976) 1986 Oct;11(8):847–850. doi: 10.1097/00007632-198610000-00022. [DOI] [PubMed] [Google Scholar]
  5. KEMP A. Een nieuw symptoom bij prolaps van de tussenwervelschijf. Ned Tijdschr Geneeskd. 1950 Jun 24;94(25):1750–1755. [PubMed] [Google Scholar]
  6. Nykvist F., Alaranta H., Hurme M., Karppi S. L. Clinical findings as outcome predictors in rehabilitation of patients with sciatica. Int J Rehabil Res. 1991;14(2):131–144. doi: 10.1097/00004356-199106000-00005. [DOI] [PubMed] [Google Scholar]
  8. Roland M., Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976) 1983 Mar;8(2):141–144. doi: 10.1097/00007632-198303000-00004. [DOI] [PubMed] [Google Scholar]
  9. Roland M., Morris R. A study of the natural history of low-back pain. Part II: development of guidelines for trials of treatment in primary care. Spine (Phila Pa 1976) 1983 Mar;8(2):145–150. doi: 10.1097/00007632-198303000-00005. [DOI] [PubMed] [Google Scholar]
  10. Saal J. A. Natural history and nonoperative treatment of lumbar disc herniation. Spine (Phila Pa 1976) 1996 Dec 15;21(24 Suppl):2S–9S. doi: 10.1097/00007632-199612151-00002. [DOI] [PubMed] [Google Scholar]
  11. Saal J. A., Saal J. S., Herzog R. J. The natural history of lumbar intervertebral disc extrusions treated nonoperatively. Spine (Phila Pa 1976) 1990 Jul;15(7):683–686. doi: 10.1097/00007632-199007000-00013. [DOI] [PubMed] [Google Scholar]
  12. Vroomen P. C., de Krom M. C., Knottnerus J. A. Consistency of history taking and physical examination in patients with suspected lumbar nerve root involvement. Spine (Phila Pa 1976) 2000 Jan;25(1):91–97. doi: 10.1097/00007632-200001010-00016. [DOI] [PubMed] [Google Scholar]
  13. Vroomen P. C., de Krom M. C., Knottnerus J. A. When does the patient with a disc herniation undergo lumbosacral discectomy? J Neurol Neurosurg Psychiatry. 2000 Jan;68(1):75–79. doi: 10.1136/jnnp.68.1.75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Vroomen P. C., de Krom M. C., Wilmink J. T., Kester A. D., Knottnerus J. A. Lack of effectiveness of bed rest for sciatica. N Engl J Med. 1999 Feb 11;340(6):418–423. doi: 10.1056/NEJM199902113400602. [DOI] [PubMed] [Google Scholar]
  15. Weber H., Holme I., Amlie E. The natural course of acute sciatica with nerve root symptoms in a double-blind placebo-controlled trial evaluating the effect of piroxicam. Spine (Phila Pa 1976) 1993 Sep 1;18(11):1433–1438. [PubMed] [Google Scholar]
  16. Wiltse L. L., Rocchio P. D. Preoperative psychological tests as predictors of success of chemonucleolysis in the treatment of the low-back syndrome. J Bone Joint Surg Am. 1975 Jun;57(4):478–483. [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES