Sciatica from disk herniation: Medical treatment or surgery?

Abstract Disk-related sciatica is a common disorder that resolves without surgery in 95% of patients within 1 to 12 months. Several treatment strategies designed to hasten recovery, enable a return to previous social and occupational activities, and prevent chronicization have been evaluated. Availa...

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Bibliographic Details
Published in:Joint, bone, spine : revue du rhumatisme bone, spine : revue du rhumatisme, 2007-12, Vol.74 (6), p.530-535
Main Authors: Legrand, Erick, Bouvard, Béatrice, Audran, Maurice, Fournier, Dominique, Valat, Jean Pierre
Format: Article
Language:English
Subjects:
Analgesics - therapeutic use
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Diskectomy
Glucocorticoids - administration & dosage
Glucocorticoids - therapeutic use
Healthcare network
Humans
Injections, Epidural
Internal Medicine
Intervertebral Disc Displacement - complications
Intervertebral Disc Displacement - physiopathology
Intervertebral Disc Displacement - therapy
Low Back Pain - etiology
Low Back Pain - physiopathology
Low Back Pain - therapy
Quality of Life
Rheumatology
Sciatica
Sciatica - complications
Sciatica - physiopathology
Sciatica - therapy
Surgery
Treatment
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Summary:Abstract Disk-related sciatica is a common disorder that resolves without surgery in 95% of patients within 1 to 12 months. Several treatment strategies designed to hasten recovery, enable a return to previous social and occupational activities, and prevent chronicization have been evaluated. Available efficacy data support the use of analgesics, nonsteroidal anti-inflammatory drugs, and epidural steroid injections, which probably relieve the pain and improve the quality of life without radically changing the midterm outcome. After a specialized evaluation of physical, psychological, social, and occupational factors, surgery may be offered to patients with persistent nerve root pain (as opposed to low back pain). The complication rate ranges from 1% to 3%. Surgery is clearly effective, shortening the time to recovery by about 50% compared to nonsurgical treatment. Whether one specific surgical procedure is better than others remains unclear. Methodological weaknesses of studies evaluating the efficacy of percutaneous methods preclude definitive conclusions. Bed rest, systemic glucocorticoid therapy, spinal manipulation, bracing, spinal traction, and physical therapy have no proven effects on the outcome of sciatica.
ISSN:1297-319X
1778-7254
DOI:10.1016/j.jbspin.2007.07.004