When a patient complains of pain from a herniated disc or sciatica, the first test a doctor will order is an MRI. This test is often used when pain is radiating down the back of the legs. It allows doctors to see the severity of the situation. Additionally, it shows the doctor whether or not surgical intervention is necessary. An MRI will show if there is an issue with a compressive nerve. However, recently, using the MRI to decide on surgery has become quite controversial. According to an article recently posted in the Journal of Neurosurgery, they discovered that this hallmark test has absolutely no way to help a doctor decide on surgery or a patient’s prolonged care.
Patients suffering from their first bout of sciatica usually, they have a good prognosis without the need for surgical intervention. Sciatica treatments are able to allow patients to have some resolution within 6-8 weeks of their initial diagnosis. When dealing with herniated discs in the lumbar area, there is a 96 percent sequestration rate of regression, a 70 percent rate for extrusion, and a 41 percent rate of a protrusion. Oddly enough, when the lesion is severe in nature, it has a better long-term prognosis, according to researchers. Sciatica treatments are not always necessary, specifically, when non-compressive sciatica is present, it often resolves on its own.
A study of 283 people proved interesting to doctors. Those studied were dealing with their initial episode of sciatica. To meet criteria, these people needed symptoms that ranged from 6-12 weeks in duration, and they must experience pain that radiated through their back and legs. Some dealt with nerve compression identified by an MRI, others did not. They divided into two categories, those that has received conservative care and those that choose to have surgical intervention early on. Within the conservative group, there were 55 people that had surgery before their one-year visit.
When nerve root compression was notated on an MRI, the patients recovered at a higher rate than those who didn’t have any compression issues. These people were in less pain at their one-year follow-up appointment. Using the Roland Disability Questionnaire, often called an RDQ, it was ironic that their back pain scores decreased. Disc intrusion patients saw a higher rate of recovery, and they had less leg pain at their one-year follow-up appointment. However, their RDQ scores were not favorable.
Strangely enough, the disc herniation size was not directly associated with the patients’ recovery rate. In the conservative group, it did not alter their decision on whether to have surgery. There was 21 percent within the group that presented with the large disc herniation. Surprisingly, the larger herniation group did not have a favorable outcome within the surgical group. The clinical expectations were not helpful. It didn’t matter whether the person had surgery or prolonged conservative treatment, it appeared that everyone faired equally.
Two previous studies showed similar results, which baffled clinicians. A problem within the sciatica can be both compressive and non-compressive, or at least that is one explanation of the test results. Those who suffer from the non-compressive versions of sciatica may have a harder time with spontaneous resolution. The patients that had a clear nerve root compression on their MRI, seemed to have an overall better prognosis.
Clearly, the test showed that an MRI is not a good indication, of whether surgery or conservative care is the best answer. However, it may be helpful in predicting a patient’s prognosis when dealing with sciatica. It did not prove to be beneficial in deciding whether a patient needed surgery or not, but it does give doctors a better view of the interior issues.
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