Frequency and determinants of surgical treatment in patients with uncomplicated disc-related sciatica hospitalized in the Rheumatology Department of Lille University Hospital.

ABSTRACT

Background: Disc-related sciatica is a frequent condition. Most cases of sciatica evolve favorably. Although several randomized controlled trials have reported that surgery is more effective than conservative management in the short-term, no significant differences in pain or functional disability have been reported in the longer term. As such, discounting complications requiring urgent intervention, surgery is generally only performed in patients in whom medical treatment has failed. Our objective was to determine the rate and predictive factors of surgical treatment one year after in-hospital conservative management of disc-related sciatica. Methods: Retrospective, observational, single-center study conducted in the Rheumatology Department of the Lille University Hospital Center between 2014 and 2018. Results: In the study population (n=405), the frequency of surgery one year after hospitalization was 34.8%. Median time to surgery was 31 days. In multivariate analysis, working [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.5; 3.6)], impulsive pain (OR 2.0, 95% CI 1.3; 3.1), motor loss (OR 1.7; 95% CI 1.2; 2.4) and number of infiltrations (OR 1.4, 95% CI 1.2; 1.7) were predictive of surgery. A decrease in numeric pain-scale rating of the leg between the beginning and end of hospitalization was associated with fewer cases of surgery (OR 0.921, 95% CI 0.861; 0.985). Conclusions: A proportion of 34.8% of the patients hospitalized for disc-related sciatica did undergo surgery within one year of our medical management protocol. Several predictive factors for surgery were found.