Introduction Based on clinical experiences and questions from relatives having suffered from sciatica I wanted to do a review of the literature comparing surgical and concervative treatment of sciatica caused by lumbar disc herniation. My impression based on my experiences before I started this review was that there was no clear consensus on what the best treatment options were.
Objective To compare the clinical effectiveness of surgical versus concervative treatment for patients with sciatica due to lumbar disc herniation.
Methods I firstly analysed and assessed a systematic review on the subject based upon articles published before october 1. 2009 and then supplied with my own literature search to find articles published after october 1. 2009 and up until today. I then tried to sum up the findings and compare these with today's guidelines as well as some of the most relevant online clinical medical resources.
Result My literature search on the subject resulted in two systematic reviews (SLRs) and three RCTs . One of the SLRs was very thorough and included several more articles than the SLR I started with, while the other was primarily written on another subject, but briefly touched on my subject. The RCTs all had quite few participants and none of them were of very high quality. One concluded that Percutane disc decompression was more effective than concervative treatment. Another found microdiscectomy to be more effective than epidural injections. And one concluded that spinal manipulation can benefit 60% of selected patients to the same degree as surgery.
Conclusion There is evidence suggesting that surgery is better than concervative treatment for short term pain relief and functional improvment, but the quality of the evidence is not very high because few high quality RCTs comparing the two have been carried out. In the long term there is not evidence suggesting one treatment is better than the other. There is indications that some patients can benefit from spinal manipulation to the same degree as surgery concerning short term improvement, but more research on the subject is needed to strenghten the degree of evidence.