Clinical Course of Motor Deficits from Lumbosacral Radiculopathy Due to Disk Herniation

Autor: Sandra Boimbo, Venu Akuthota, Ben Marshall, Christopher T. Plastaras, Mark C. Osborne, Kelly Sauerwein, Marzena Buzanowska, Gerard J. Garvan, Balaji V. Sridhar, Cynthia S. Garvan
Rok vydání: 2019
Předmět:
Adult
Male
030506 rehabilitation
medicine.medical_specialty
Weakness
Colorado
Visual analogue scale
medicine.medical_treatment
Physical Therapy
Sports Therapy and Rehabilitation
Conservative Treatment
Ambulatory Care Facilities
Severity of Illness Index
Statistics
Nonparametric
Disability Evaluation
03 medical and health sciences
0302 clinical medicine
Severity of illness
Humans
Pain Management
Medicine
Prospective Studies
Radiculopathy
Prospective cohort study
Pain Measurement
Academic Medical Centers
Chi-Square Distribution
Muscle Weakness
Rehabilitation
business.industry
Lumbosacral Region
Recovery of Function
Middle Aged
Oswestry Disability Index
Treatment Outcome
Neurology
Motor Skills
Cohort
Physical therapy
Female
Neurology (clinical)
medicine.symptom
0305 other medical science
business
Chi-squared distribution
Intervertebral Disc Displacement
030217 neurology & neurosurgery
Follow-Up Studies
Zdroj: PM&R. 11:807-814
ISSN: 1934-1563
1934-1482
Popis: Background The clinical course of motor deficits from lumbosacral radiculopathy appears to improve with or without surgery. Strength measurements have been confined to manual muscle testing (MMT) and have not been extensively followed and quantified in prior studies. Objective To determine if motor weakness and patient-reported outcomes related to lumbosacral radiculopathy improve without surgical intervention over the course of 12 months. Design Prospective observational cohort. Setting Outpatient academic spine practice. Participants Adults with acute radicular weakness due to disk herniation. Methods Forty patients with radiculopathy and strength deficit were followed over a 12-month period. Objective strength and performance tests as well as survey-based measurements were collected at baseline and then every 3 months. Patients underwent comprehensive pain management and rehabilitation and/or surgical approaches as determined in coordination with the treating specialist. This study was approved by the institutional review board of Colorado. Main outcome measurements Testing of strength was through MMT, handheld dynamometer, and performance-based testing. Furthermore, visual analog scale, modified Oswestry Disability Index, and 36-Item Short Form Health Survey (SF-36) were used to measure pain and disability outcomes. Results Of the 40 patients, 33 (82.5%) did not have surgery; 7 (17.5%) had surgery. Twenty-four of the 33 patients (60%) did not undergo surgery and were followed for 12 months (Comprehensive Pain Management and Rehabilitation, Complete [CPM&R-C]), and 9 (22%) did not have surgery and lacked at least one follow-up evaluation (Comprehensive Pain Management and Rehabilitation, Incomplete [CPM&R-I]). No statistically significant differences were found on baseline measures of strength deficits and SF-36 domains between the CPM&R-C, Surgery, and CPM&R-I groups. Pain and disability scores in the Surgery group were significantly higher than in the CPM&R-C at baseline. There were statistically significant improvements in all areas of strength, pain, and function when comparing measurements at the 12-month follow-up to baseline in the CPM&R-C group. Conclusions Individuals with motor deficits due to lumbosacral radiculopathy improve over time regardless of treatment choice. Most did not choose surgery, and almost all of these patients regained full strength at 1 year. Strength recovery typically occurred in the first 3 months, but there was ongoing recovery over the course of a year. Level of evidence II.
Databáze: OpenAIRE
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