Timing of surgery for sciatica: subgroup analysis alongside a randomized trial.

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
Wilco C PeulBart W Koes

Abstract

Surgery speeds up recovery for sciatica. Prolonged conservative care with surgery for those patients with persistent sciatica however, yields similar results at 1 year. To investigate whether baseline variables modify the difference in recovery rates between these treatment strategies, baseline data of 283 patients enrolled in a randomized trial, comparing early surgery with prolonged conservative care, were used to analyse effect modification of the allotted treatment strategy. For predictors shown to modify the effect of the treatment strategy, repeated measurement analyses with the Roland Disability Questionnaire and visual analogue scale pain as continuous outcomes were performed for every level of that predictor. Presumed predictive variables did not have any interaction with treatment, while "sciatica provoked by sitting" showed to be a significant effect modifier (P = 0.07). In a Cox model we estimated a hazard ratio (HR, surgery versus conservative) of 2.2 (95% CI 1.7-3.0) in favour of surgery when sciatica was provoked by sitting, while the HR was 1.3 (95% CI 0.8-2.2) when this sign was absent. The interaction effect is marginally significant (interactions are usually tested at the 10% level) but the patterns generated...Continue Reading

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Citations

Dec 18, 2009·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Michel Benoist
Dec 22, 2009·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Robert C Mulholland
Jan 13, 2011·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·F S KleinstueckF Porchet
Mar 3, 2011·Acta neurochirurgica·Mark P ArtsUNKNOWN Leiden-Hague Spine Intervention Prognostic Study Group
Dec 3, 2009·Journal of Neurosurgery. Spine·Jörg FrankeHenning Grasshoff
Apr 18, 2014·Indian Journal of Orthopaedics·Ashutosh B Sabnis, Ashish D Diwan
Aug 26, 2014·The Spine Journal : Official Journal of the North American Spine Society·Jon D Lurie
Feb 16, 2011·The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques·Fred L CohenMark Bernstein
Feb 13, 2016·Journal of Neurosurgery. Spine·Abdelilah El BarzouhiUNKNOWN Leiden–The Hague Spine Intervention Prognostic Study Group
Jul 16, 2013·The Spine Journal : Official Journal of the North American Spine Society·Jeffrey A QuonMartin T Schechter
Sep 4, 2015·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Daniel SteffensChris G Maher
Feb 15, 2014·Clinical Orthopaedics and Related Research·Andrew J Schoenfeld, Christopher M Bono
Sep 30, 2014·The Spine Journal : Official Journal of the North American Spine Society·Sigita BurneikieneAlan T Villavicencio
Jul 6, 2019·BMC Musculoskeletal Disorders·Kika KonstantinouUNKNOWN SCOPiC study team
Oct 13, 2020·Health Technology Assessment : HTA·Nadine E FosterKate M Dunn

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