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Title:

Predictors of patient-reported recovery from motor or sensory deficits two years after acute symptomatic lumbar disk herniation

Author(s):

Year:

2012

Publication Info:

PM R, 4(12):936-944

Abstract:

OBJECTIVE: To determine the prevalence of patient-reported recovery from motor or sensory deficits over 2 years of follow-up after acute symptomatic lumbar disk herniation and to identify predictors of perceived recovery.
DESIGN: A prospective inception cohort.
SETTING: An outpatient spine clinic.
PATIENTS: Consecutive adults with lumbosacral radicular syndrome (onset =12 weeks) due to symptomatic lumbar disk herniation, confirmed by magnetic resonance imaging: 95 patients with a baseline motor deficit by physical examination and 59 patients with a baseline sensory deficit by physical examination.
METHODS: The patients received individualized nonsurgical treatment or, in a minority of cases, surgical treatment. All of the patients underwent a standardized baseline neurologic examination, including motor and sensory testing. Patients with a motor or sensory deficit at the baseline examination reported on whether they perceived persisting weakness or sensory deficits at 1- and 2-year follow-up. We calculated the 1- and 2-year prevalence of patient-reported persisting weakness or sensory deficits. We examined factors associated with perceived recovery from motor or sensory deficits by using bivariate analyses and multivariate logistic regression.
RESULTS: Among patients with a baseline motor deficit, the prevalence of patient-reported continuing weakness was 38% at 1 year and 25% at 2 years. Among patients with a baseline sensory deficit, the prevalence of patient-reported continuing sensory deficits was 53% at 1 year and 47% at 2 years. A positive straight leg raise test (odds ratio [OR] 0.26 [95% confidence interval (CI) 0.08-0.83]) and opioid use (OR 0.24 [95% CI 0.06-0.83]) were independently and negatively predictive of patient-reported motor recovery. Female gender was independently and negatively predictive of patient-reported sensory recovery (OR 0.20 [95% CI 0.04-0.99]).
CONCLUSIONS: Patient-reported recovery from motor deficits after lumbar disk herniation occurs for 75% of patients over 2 years, but recovery from sensory deficits over this time frame occurs in only 53% of patients. A positive straight-leg raise test and female gender may predict poor recovery from motor and sensory deficits, respectively.

Link to Article:

http://www.ncbi.nlm.nih.gov/pubmed/23153857

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