Surgical versus non-surgical treatment for sciatica: systematic review and meta-analysis of randomised controlled trials

Key Points

1. Very low to low certainty evidence suggested that discectomy was superior to non-surgical treatment or epidural steroid injection for reducing leg pain and disability in people with sciatica due to disc herniation.

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BACKGROUND & OBJECTIVE

Guidelines recommend a stepwise model of treatment for sciatica starting with non-surgical treatment such as exercise, then progressing to pharmacological and interventional treatment if the pain is refractory. Surgical treatment for sciatica caused by disc herniation is common, but the supporting evidence is uncertain.

This paper is a systematic review and meta-analysis examining the effectiveness and safety of surgery for sciatica compared with non-surgical treatment.

The study focused on discectomy because it is the most common surgical treatment for sciatica.

Surgical treatment for sciatica caused by disc herniation is common, but the supporting evidence is uncertain.

Clinicians should be aware of this information when advising clients with sciatica, especially those who are in need of immediate pain relief.

METHODS

The authors selected randomized controlled trials comparing any surgical treatment for sciatica due to disc herniation with any non-surgical treatment, including epidural steroid injection, placebo, or sham surgery.

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