Article

OBJECTIVE: To determine risks and predictors of recurrent leg and low back pain
(LBP) after unstructured, usual nonoperative care for subacute/chronic
symptomatic lumbar disk herniation (LDH). DESIGN: Secondary analysis of data from
a concurrent randomized trial and observational cohort study. SETTING: Thirteen
outpatient spine practices. PARTICIPANTS: A total of 199 participants with
resolution of leg pain and 142 participants with resolution of LBP from among 478
participants receiving usual nonoperative care for symptomatic LDH. ASSESSMENT OF
RISK FACTORS: Potential predictors of recurrence included time to initial symptom
resolution, sociodemographics, clinical characteristics, work-related factors,
imaging-detected herniation characteristics, and baseline pain bothersomeness.
MAIN OUTCOME MEASUREMENTS: Leg pain and LBP bothersomeness were assessed by the
use of a 0-6 numerical scale at up to 4 years of follow-up. For individuals with
initial resolution of leg pain, we defined recurrent leg pain as having leg pain,
receiving lumbar epidural steroid injections, or undergoing lumbar surgery
subsequent to initial leg pain resolution. We calculated cumulative risks of
recurrence by using Kaplan-Meier survival plots and examined predictors of
recurrence using Cox proportional hazards models. We used similar definitions for
LBP recurrence. RESULTS: One- and 3-year cumulative recurrence risks were 23% and
51% for leg pain, and 28% and 70% for LBP, respectively. Early leg pain
resolution did not predict future leg pain recurrence. Complete leg pain
resolution (adjusted hazard ratio [aHR] 0.47, 95% confidence interval [CI]
0.31-0.72) and posterolateral herniation location (aHR 0.61; 95% CI 0.39-0.97)
predicted a lower risk of leg pain recurrence, and joint problems (aHR 1.89; 95%
CI 1.16-3.05) and smoking (aHR 1.81; 95% CI 1.07-3.05) predicted a greater risk
of leg pain recurrence. For participants with complete initial resolution of
pain, recurrence risks at 1 and 3 years were 16% and 41% for leg pain and 24% and
59% for LBP, respectively. CONCLUSIONS: Recurrence of pain is common after
unstructured, usual nonsurgical care for LDH. These risk estimates depend on the
specific definitions applied, and the predictors identified require replication
in future studies.
CI - Copyright (c) 2016 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS