Systematic Review of Surgery versus Conservative Management of Sciatica due to a Lumbar Herniated Disc

Sciatica is a medical condition characterized by pain going down the leg from lower back due to lumbar herniated disc which posing a great health burden and decrease patient's quality of life. The aim of the paper compares and summarizes the evidence regarding the effectiveness of surgery compared with conservative treatment for patients with sciatica due to lumbar disc herniation. At Department of Orthopedic Surgery, Al-Zahraa University Hospital, Faculty of Medicine for Girls, Al Azhar University for one year from 1st January 2021 to 30th December 2021. We conducted an electronic search through different databases; PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar. We included clinical trials whether randomized or nonrandomized, prospective or retrospective, cohorts and case control studies. We included studies that compared surgery to non-surgical interventions and enrolled adult patients (more than 18 years of age) subjects with sciatica due to a herniated disc. We identified eleven studies that compared directly surgical treatment to conservative measures in patients with sciatica due to a lumbar herniated disc. Our main outcomes were Visual Analogue scale (VAS) at low Back or Leg pain, Oswestry Disability Index (ODI), Roland Disability Questionnaire (RDQ), and SF-36 scale at various points of follow up. VAS score showed surgical treatment had significant reduction in pain at short term and mid-term but on the long term there was no significant difference. While ODI showed significantly better results in the surgical arm at all points, short term, mid-term treatment and long term. Similarly, SF-36 scale showed significant difference favoring the surgical treatment. On the contrary, on RDQ, there was no significant difference between either arm, short term or long-term. Surgical treatment was superior to conservative treatment in the short term. However, it is not clear if this effect is sustained in the long term. Till now, in the absence of clear indications for surgery, the need for intervention is decided by the surgeon to determine which treatment strategy is best for them.