Article

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.
CI - Copyright (c) 2012 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS