Barzouhi AE, Vleggeert-Lankamp LAM, Nijeholt GJL et al Magnetic resonance imaging in follow-up assessment of sciatica New Engl J Med 2013;368(11):999-1007
- We report on the radiologic findings (MRI in patients with known lumbar disk herniation) at 1 year, changes in these findings over time, and their correlation with clinical outcome.
- One year after randomization, results on a second MRI were available for 267 patients.
- Association between MRI findings and clinical outcome
- At 1 year, disk herniation was visible in 35% of the patients with a favorable outcome and in 33% of those with an unfavorable outcome
- Readers’ rating on the 4-point scale assessing the presence of disk herniation on MRI did not distinguish between patients with a favorable outcome versus those with an unfavorable outcome.
- After adjustment for randomized treatment, the presence of disk herniation on MRI was not associated with a favorable outcome at 1 year.
- discussion
- In this study of patients with symptomatic lumbar disk herniation at baseline who were treated with either surgery or conservative treatment and followed for 1 year, the presence of disk disk herniation on MRI at 1-year follow-up did not distinguish patients with a favorable clinical outcome from those with an unfavorable outcome. Therefore, patients asking for reimaging because of persistent or recurrent symptoms should be informed about the difficulty in MRI interpretation after a first episode of acute sciatica.
- We did not find a positive correlation between the presence of scar tissue and symptoms.
- In summary, in patients who had undergone repeated MRI 1 year after treatment for symptomatic lumbar-disk hernination, anatomical abnormalities that were visible on MRI did not distinguish patients with persistent or recurrent symptoms of sciatica from asymptomatic patients. Further research is needed to assess the value of MRI in clinical decision making for patients with persistent or recurrent sciatica.
