terça-feira, 12 de novembro de 2013
PARALISIAS NAS HÉRNIAS DE DISCO SÃO DE EVOLUÇÃO BENIGNA. NÃO VALE OPERAR POR ISSO!
Spine (Phila Pa 1976). 2002 Jul 1;27(13):1426-31; discussion 1431.
Dubourg G, Rozenberg S, Fautrel B, Valls-Bellec I, Bissery A, Lang T, Faillot T, Duplan B, Briançon D, Levy-Weil F, Morlock G, Crouzet J, Gatfosse M, Bonnet C,Houvenagel E, Hary S, Brocq O, Poiraudeau S, Beaudreuil J, de Sauverzac C, Durieux S, Levade MH, Esposito P, Maitrot D, Goupille P, Valat JP, Bourgeois P.
Service de Rhumatologie, CHU Pitié-Salpêtrière, Paris, France. firstname.lastname@example.org
Although 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.
To assess the course of sciatica with discogenic paresis and to determine possible prognostic factors for recovery or improvement.
This 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.
Sixty-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.
This 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.