Predictors of Patient-Reported Recovery From Motor or Sensory Deficits Two Years After Acute Symptomatic Lumbar Disk Herniation

December 2012
Publication year: 2012
Source:PM&R, Volume 4, Issue 12



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.

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