Peul Wilco C, Brand Ronald, Thomeer Ralph T W M, Koes Bart W
Department of Neurosurgery, Leiden University Medical Center/Medical Center Haaglanden, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands Department of General Practice, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Pain. 2008 Sep 15;138(3):571-576. doi: 10.1016/j.pain.2008.02.011. Epub 2008 Mar 10.
A randomized trial showed that surgery speeds up recovery of patients suffering sciatica for 6 weeks but prolonged conservative care yields similar results at one year. However 39% of this conservative care group ultimately underwent surgery after a mean period of 18.7 weeks. We evaluated variables to improve prediction of surgery in the conservatively treated cohort. Baseline data on 142 patients enroled in the conservative treatment arm of a randomized trial were analyzed to select those that could contribute to the prediction of surgery. The actual occurrence of surgery was used as dependent outcome of interest. Variables measured at baseline included neurological examination results, the visual analogue scale for pain (VAS) and the Roland disability questionnaire (RDQ). Higher pain intensity and functional limitations at baseline were associated with an increased likelihood of surgery during follow-up. Mutually adjusted Odds Ratios of 1.7 (95% CI; 1.1-2.7) per 20mm incremental intensification of pain on the VAS score and 1.8 (95% CI; 1.2-2.9) per 3 points of deterioration of the RDQ score quantify the increasing chance of undergoing delayed surgery. Despite maximal efforts to the contrary, surgery could not be prevented for a considerable proportion of patients in a conservatively treated cohort. Compared to those with lower scores initially, patients with more intense leg pain or higher disability scores were at higher risk to undergo delayed surgery. The individual surgical decision process is facilitated by the use of pain and disability scales complemented by patient preferences.
一项随机试验表明，手术可加快坐骨神经痛患者6周的恢复速度，但长期的保守治疗在一年后也能产生类似的效果。然而，该保守治疗组中有39%的患者在平均18.7周后最终接受了手术。我们评估了一些变量，以改善对保守治疗队列中手术情况的预测。分析了一项随机试验保守治疗组中142名患者的基线数据，以筛选出那些有助于预测手术的因素。手术的实际发生情况被用作感兴趣的相关结果。在基线时测量的变量包括神经学检查结果、疼痛视觉模拟量表（VAS）和罗兰残疾问卷（RDQ）。基线时较高的疼痛强度和功能受限与随访期间手术可能性增加相关。VAS评分每增加20mm疼痛强度，相互调整后的优势比为1.7（95%可信区间：1.1 - 2.7）；RDQ评分每恶化3分，优势比为1.8（95%可信区间：1.2 - 2.9），这量化了接受延迟手术几率的增加。尽管已尽最大努力避免，但在保守治疗队列中仍有相当一部分患者无法避免手术。与最初评分较低的患者相比，腿部疼痛更剧烈或残疾评分更高的患者接受延迟手术的风险更高。使用疼痛和残疾量表并结合患者偏好有助于个人手术决策过程。
