| Sciatica: Studies of symptoms, genetic factors, and treatment with periradicular infiltration | ||
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A total of 277 trial candidates were contacted by the principal author from January 1997 to May 1998. Of the 171 eligible patients, 8 refused to take participate. None specified the reason for refusal. Of the remaining 163 patients, 3 were withdrawn by the radiologist (envelopes unsealed) because typical neurograms were not produced. Of the final study population (160 patients), 97 were men and 63 women. The mean age of the patients was 43.7 years (range 19–78 years), and the mean duration of symptoms 2.5 months. Their clinical signs and symptoms are presented in Table 1.
Five patients had L4, 89 had L5, and 66 had S1 radiculopathy. MRI identified a disc herniation corresponding to the symptoms in 131 (82 %) patients, as well as nerve root enhancement in 3 patients with a non-herniated symptomatic disc. The degree of disc displacement was graded bulge (or normal) in 29 (18%), as contained herniation in 50 (31%), as noncontained herniation in 68 (43%) and as sequester in 13 (8%) patients.
Table 1. Baseline characteristics of 160 patients with sciatica randomly assigned to receive periradicular infiltration either with methylprednisolone-bupivacaine or saline.*
| Characteristic | Methylprednisolone- bupivacaine (n = 80) | Saline (n = 80) | Total (n = 160) |
|---|---|---|---|
| Age (year) | 43.813 | 43.713 | 43.713 |
| Male gender (%) | 64 | 58 | 61 |
| High school graduates (%) | 15 | 16 | 16 |
| Work-related features | |||
| Employed (%) | 73 | 78 | 75 |
| Retired (%) | 11 | 11 | 11 |
| Others (unemployed, students) | 16 | 11 | 14 |
| Duration of sciatica (months) | 2.41.5 | 2.61.5 | 2.51.5 |
| First or second episode of sciatica (%) | 59 | 47 | 53 |
| Level affected on MRI (%) | |||
| L3-L4 | 3 | 5 | 4 |
| L4-L5 | 61 | 40 | 51 |
| L5-S1 | 36 | 55 | 45 |
| MRI-classification of the symptomatic disc (%) | |||
| Bulge or normal | 22 | 14 | 18 |
| Contained herniation | 30 | 32 | 31 |
| Extrusion | 48 | 54 | 51 |
| Leg pain intensity (100-mm VAS) | 71 18 | 75 19 | 73 18 |
| Back pain intensity (100-mm VAS) | 53 25 | 60 25 | 56 25 |
| Oswestry score (%) | 43 16 | 44 15 | 43 15 |
| Nottingham Health Profile§ | |||
| Dimension of energy | 21 28 | 17 25 | 19 27 |
| Dimension of emotional reactions | 11 15 | 10 13 | 10 14 |
| Dimension of sleep | 28 32 | 31 31 | 29 31 |
| Dimension of pain | 66 26 | 72 25 | 69 26 |
| Dimension of mobility | 33 19 | 34 17 | 34 18 |
| Dimension of social isolation | 4 9 | 2 8 | 3 8 |
| Mean duration of sick leave (days) | 14 18 | 22 26 | 18 23 |
| Physical measures | |||
| Straight leg raising test (°) | 58 18 | 60 19 | 59 19 |
| Lumbar flexion (cm)¶ | 4.81.5 | 4.91.5 | 4.81.5 |
| Motor deficit (% ) | 24 | 20 | 22 |
| * Mean SD values shown unless otherwise stated. § The scores of the Nottingham Health Profile range from 0 to 100, with higher scores indicating worse health-related quality in each dimension.¶ Measured by the modified Schober method (the difference between a 15-cm distance marked on the back of the patient in a standing position and distance with the patient in full flexion). | |||