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Factors Associated with Lumbar Disc Herniation Chris
Gregg
MSc, Chris Hoffman MD, Omid Yassaie MD
Introduction: Radicular leg pain can be a painful and debilitating condition that usually results from a lumbar disc herniation (LDH) and associated nerve root compression. The optimal criteria to diagnose a LDH still remains uncertain although recent research has suggested that a collection of patient signs and symptoms may form the most accurate model for predicting LDH on MRI. Methods: This was a retrospective, observational study across ten rehabilitation clinics in New Zealand. Patients were admitted into the study if they had symptoms of radicular leg pain and were subsequently referred for subsequent Magnetic Resonance Imaging (MRI). Statistical analysis was completed to determine the association between potential prognostic variables recorded at the initial assessment (including: pain level, age, smoking history, employment status, symptom duration, perceived functional capacity, Straight Leg Raise (SLR), neurological integrity and diagnostic pattern) and MRI result confirming a lumbar disc herniation. Results: The final sample group comprised 155 patients with a mean age of 44 years. There was no statistically significant association between pain level, neurological loss, symptom duration, perceived function, dominant pain site and the eventual MRI finding. Three variables recorded at assessment had a statistically significant association with a LDH; positive straight leg raise, sleep disturbance and older age. Patients presenting with two variables had an odds ratio of 7.6 times and patients who had three of these variables were 8.8 times more likely to have a LDH on MRI scan compared to those that did not present with any of these signs. Conclusion: Our study suggests that SLR, sleep disturbance and increasing age correlate with having a positive LDH on MRI scan and these symptoms and signs should be considered when imaging patients with suspected LDH. |