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Nonoperative Treatment for Lumbosacral Radiculopathy: What Factors Predict Treatment Failure?

  • Symposium: Current Approaches to the Management of Lumbar Disc Herniation
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Prior studies of nonoperative treatment for lumbosacral radiculopathy have identified potential predictors of treatment failure, defined by persistent pain, persistent disability, lack of recovery, or subsequent surgery. However, few predictors have been replicated, with the exception of higher leg pain intensity, as a predictor of subsequent surgery.

Questions/purposes

We asked two research questions: (1) Does higher baseline leg pain intensity predict subsequent lumbar surgery? (2) Can other previously identified “candidate” predictors of nonoperative treatment failure be replicated?

Methods

Between January 2008 and March 2009, 154 participants with acute lumbosacral radicular pain were enrolled in a prospective database; 128 participants (83%) received nonoperative treatment and 26 (17%) received surgery over 2-year followup. Ninety-four nonoperative participants (73%) responded to followup questionnaires. We examined associations between previously identified “candidate” predictors and treatment failure defined as (1) subsequent surgery; (2) persistent leg pain on a visual analog scale; (3) persistent disability on the Oswestry Disability Index; or (4) participant-reported lack of recovery over 2-year followup. Confounding variables including sociodemographics, clinical factors, and imaging characteristics were evaluated using an exploratory bivariate analysis followed by a multivariate analysis.

Results

With the numbers available, higher baseline leg pain intensity was not an independent predictor of subsequent surgery (adjusted odds ratio [aOR], 1.22 per point of baseline leg pain; 95% confidence interval [CI], 0.98–1.53; p = 0.08). Prior low back pain (aOR, 4.79; 95% CI, 1.01–22.7; p = 0.05) and a positive straight leg raise test (aOR, 4.38; 95% CI, 1.60–11.9; p = 0.004) predicted subsequent surgery. Workers compensation claims predicted persistent leg pain (aOR, 9.04; 95% CI, 1.01–81; p = 0.05) and disability (aOR, 5.99; 95% CI, 1.09–32.7; p = 0.04). Female sex predicted persistent disability (aOR, 3.16; 95% CI, 1.03–9.69; p = 0.05) and perceived lack of recovery (aOR, 2.44; 95% CI, 1.02–5.84; p = 0.05).

Conclusions

Higher baseline leg pain intensity was not confirmed as a predictor of subsequent surgery. However, the directionality of the association seen was consistent with prior reports, suggesting Type II error as a possible explanation; larger studies are needed to further examine this relationship. Clinicians should be aware of potential factors that may predict nonoperative treatment failure, including prior low back pain or a positive straight leg raise test as predictors of subsequent surgery, workers compensation claims as predictors of persistent leg pain and disability, and female sex as a predictor of persistent disability and lack of recovery.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank the study participants for their time and effort.

Author information

Authors and Affiliations

  1. VA Puget Sound Healthcare System, 1660 S Columbian Way, RCS-117, Seattle, WA, 98108, USA

    Pradeep Suri MD, MS

  2. Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA

    Pradeep Suri MD, MS & M. Jake Carlson MD

  3. New England Baptist Hospital, Boston, MA, USA

    James Rainville MD

  4. Harvard Medical School, Boston, MA, USA

    James Rainville MD

Authors
  1. Pradeep Suri MD, MS
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  2. M. Jake Carlson MD
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  3. James Rainville MD
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Corresponding author

Correspondence to Pradeep Suri MD, MS.

Additional information

VA Puget Sound provided support for one of the author’s (PS) participation in this research. A portion of this research was conducted while this author was funded by the Rehabilitation Medicine Scientist Training K12 Program (RMSTP) and the National Institutes of Health (K12 HD 01097).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

This research was approved by the New England Baptist Hospital Institutional Review Board. Each author certifies that the New England Baptist Hospital Institutional Review Board approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at New England Baptist Hospital, Boston, MA, USA.

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Suri, P., Carlson, M.J. & Rainville, J. Nonoperative Treatment for Lumbosacral Radiculopathy: What Factors Predict Treatment Failure?. Clin Orthop Relat Res 473, 1931–1939 (2015). https://doi.org/10.1007/s11999-014-3677-8

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  • DOI: https://doi.org/10.1007/s11999-014-3677-8

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