Article

OBJECTIVES: To determine recurrence rates of lower-extremity radicular pain after
nonsurgical treatment of acute symptomatic lumbar disk herniation (LDH), and to
identify predictors of recurrence. DESIGN: Prospective inception cohort. SETTING:
Outpatient spine clinic. PARTICIPANTS: Patients (N=79) reporting resolution of
radicular pain after magnetic resonance imaging confirmation of LDH.
INTERVENTIONS: Individualized nonsurgical treatment tailored to the patient. All
patients received education, but other treatments varied depending on the
individual. MAIN OUTCOME MEASURES: Resolution of radicular pain was defined as a
pain-free period of >/=1 month. Patients who reported resolution of radicular
pain within 1 year after seeking care for acute LDH were asked whether pain had
recurred at 1 year after seeking care and were also reassessed 1 year after the
time of resolution of radicular pain and 2 years after seeking care. Patients
reported on recurrence and the date of recurrence, if any. We evaluated the
1-year incidence of recurrence, using Kaplan-Meier survival plots. We examined
predictors of recurrence using bivariate and multivariate Cox proportional
hazards models. We examined the secondary outcome of back pain recurrence using
identical methods. RESULTS: Twenty-five percent (95% confidence interval [CI],
15-35) of individuals with resolution of radicular pain for at least 1 month
reported subsequent recurrence of pain within 1 year after resolution. The only
factor independently associated with radicular pain recurrence was the number of
months prior to resolution of pain (hazard ratio per month=1.24; 95% CI,
1.13-1.37; P<.001). The 1-year incidence of back pain recurrence was 43% (95% CI,
30-56), and older age decreased the hazard of recurrence. CONCLUSIONS: Recurrence
of radicular pain is relatively common after nonsurgical treatment of LDH and is
predicted by longer time to initial resolution of pain.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS