• Genevieve Dubourg, Sylvie Rozenberg, Bruno Fautrel, Isabelle Valls-Bellec, Anne Bissery, Thierry Lang, Thierry Faillot, Bernard Duplan, Daniel Briançon, Françoise Levy-Weil, Gilles Morlock, Jacques Crouzet, Michel Gatfosse, Christine Bonnet, Eric Houvenagel, Stéphane Hary, Olivier Brocq, Serge Poiraudeau, Johann Beaudreuil, Catherine de Sauverzac, Stephanie Durieux, Marc-Henri Levade, Philippe Esposito, Daniel Maitrot, Philippe Goupille, Jean-Pierre Valat, and Pierre Bourgeois.
• Service de Rhumatologie, CHU Pitié-Salpêtrière, Paris, France. genevieve.dubourg@psl.ap-hop-paris.fr
• Spine. 2002 Jul 1; 27 (13): 1426-31; discussion 1431.

BackgroundAlthough the existence of a motor defect in discogenic sciatica is a sign of severity, the literature does not provide evidence for an immediate requirement for surgery.ObjectiveTo assess the course of sciatica with discogenic paresis and to determine possible prognostic factors for recovery or improvement.Study DesignThis open prospective multicenter study included patients with discogenic sciatica with paresis that had been developing for less than 1 month and was rated < or =3 on a 5-grade scale. Pain, the strength of 11 muscles, return to work, and analgesic intake were assessed at 1, 3, and 6 months. Recovery and improvement were defined by pain not exceeding 20 mm or < or =50% of the initial pain score and a score of either 5 (recovery) or 4 (improvement) for the weakest muscle at inclusion.ResultsSixty-seven patients were enrolled; 39 (58%) patients were treated surgically and 28 (42%) medically. Surgically treated patients differed from medically treated patients by a higher rate of extruded herniation, a higher number of paretic muscles (6.3 vs. 5; P = 0.051), and a longer course of sciatica (31.4 vs. 17.3 days; P = 0.034). At 6 months, 7 (10.4%) patients were lost to follow-up; 32 (53.3%) had improved, including 18 (30%) recovered, 33 (85%) back to work and having a professional activity, and 22 (39%) still taking analgesics. The only significant difference between recovered and not recovered patients was mean age at inclusion (43 vs. 51 years, P = 0.034). There were no significant differences between improved and not improved patients. Moreover, the outcome was not different in the two treatment groups: there were 17 (53%) improvements in surgically treated patients, including 8 (25%) recoveries, and 14 (56%) improvements in medically treated patients, including 8 (40%) recoveries.ConclusionThis pilot study showed no difference between surgical or medical management for recovery or improvement in patients with discogenic paresis. These results need confirmation by a randomized study.

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