Evidence-based prognostication in a case of sciatica

• Published in: Journal of the Canadian Chiropractic Association 2015, Vol.59 (1), p.24-29
• Main Author: Emary, Peter C
• Format: Article
• Language: English
• Subjects: Care and treatment; Chronic pain; Complications and side effects; Evidence-based practice; Management; Medical prognosis; NMR; Nuclear magnetic resonance; Original; Pain management; Prognosis; Sciatica; Tendons
• ISSN: 0008-3194; 1715-6181

To present an evidence-based case report on the prognosis of a patient with sciatica. A 43-year-old man presented with right-sided buttock and lower extremity pain and numbness of 10 weeks' duration. Magnetic resonance imaging revealed a lumbosacral disc herniation. Straight leg raise testing provoked the patient's right sciatic pain, and neurologic examination revealed a diminished right Achilles tendon reflex and mild hypoesthesia along the patient's outer right foot. PubMed was searched and two cohort studies relevant to sciatic prognosis were found. These articles were critically appraised for their validity, importance, and applicability in making a prognostic estimate for this particular patient. Based on the appraised research evidence, and the confidence intervals calculated therein, the overall prognosis for sciatic pain recovery with conservative care was estimated as favourable for this patient, though sensory recovery (even with surgical care) was not. This case report illustrates how to use research literature in estimating the clinical prognosis for an individual patient, and how this can be useful towards clinical decision-making concerning treatment.