Discectomy for sciatica provides short-term relief for leg pain

Reference

Liu C, Ferreira GE, Abdel Shaheed C, et al. Surgical versus non-surgical treatment for sciatica: systematic review and meta-analysis of randomised controlled trials. BMJ 2023 Apr 19;381:e070730.

Synopsis

These investigators searched 6 databases, including 2 trial registries, to identify randomized controlled trials that evaluated surgery in people with sciatica of any duration due to lumbar disc herniation. Two authors independently selected articles for inclusion, extracted the data, and evaluated the quality of the studies. Most of the studies (75%) were not double-masked. Publication bias was not evaluated. Discectomy, as compared with nonsurgical treatment (including placebo) or epidural steroid injection, produced a moderately greater reduction in leg pain and back pain for the first 3 months following surgery that became a minimally greater reduction after that (very low to low certainty evidence due to high heterogeneity). Quality of life was not different among treatments. In direct comparison with epidural steroid, discectomy was more effective to decrease leg pain, in both the short term and long term (very low to low certainty based on low study bias). Disability was lessened immediately after surgery but was not different within 6 weeks. Back pain was slightly improved with surgery, but the difference dissipated after 3 months. Plasma disc decompression had a small benefit on leg pain (low certainty evidence) and moderate to large effect on reducing disability that lasted long term. Nucleolysis using condoliase but not chymopapain produced a moderate effect on leg pain in both the short term and long term (low certainty) and small effects on disability.