Conservative treatment of sciatica: A systematic review

Most patients with sciatica (often caused by disc herniations) are managed conservatively at first. The natural course seems to be favorable. The addi tional value of many conservative therapies remains controversial. Because a systematic review of the conservative treatment of sciatica is lacking, s uch a review was carried out. After a standardized literature search and se lection procedure, methodology and outcome of randomized controlled trials (RCTs) were assessed by three observers. If possible, trial results were st atistically pooled (:= metaanalysis). The 19 RCTs that were selected showed greatly varying methodologic quality. Pooled odds ratios were calculated f or several treatment types. Neither traction, exercise therapy, nor drug th erapy was unequivocally effective. Epidural steroids may be beneficial for subgroups of nerve root compression. The literature suggests possible effec tiveness of epidural steroids for sciatica. The authors recommend trials to investigate this treatment option further, especially with regard to patie nt subgroups (e.g., acute sciatica). The effects of clinical heterogeneity and methodology on review results are illustrated.