Little benefit from surgery for sciatica

Treating sciatica with surgery may not benefit patients over the long term, researchers reported last night.

The evidence supporting surgery for sciatica is unclear, Australian researchers say. Professor Christine Lin of the University of Sydney, Australia, and colleagues looked at the effectiveness and safety of surgery compared with non-surgical treatment.

They analysed 24 trials and found “very low to low certainty evidence” that discectomy surgery reduced leg pain compared with non-surgical treatment.

The effect size was moderate immediately afterwards and in the short term, and small in the medium term. “Negligible effects were noted at long term,” they add.

In the BMJ today, they state: “For disability, small, negligible, or no effects were found.

“Discectomy might be an option for people with sciatica who feel that the rapid relief offered by discectomy outweighs the risks and costs associated with surgery,” they write.

Adverse events including wound infection, repeat disc herniation, and persistent postsurgical pain, were similar with both surgical and non surgical treatment.

The authors point out: “This review provides the most comprehensive synthesis of the evidence on surgical procedures for sciatica to date.

“Different from recent reviews, we included trials of a homogeneous population, surgical procedure, comparator, studies published in English and other languages, and new robust trials, making this review the most comprehensive update on the evidence for the surgical management of sciatica.”

Liu, C. et al. Surgical versus non-surgical treatment for sciatica: systematic review and meta-analysis of randomised controlled trials. BMJ 19 April 2023; doi: 10.1136/bmj-2022-070730


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