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Dr Laurent Grange (Rheumatologist)
Sometimes proposed in the face of painful and debilitating sciatica, surgery would have little advantage over other possible treatments, concludes a recent meta-analysis of various studies on the subject.
Do we have to go through surgery to end sciatica? Not necessarily, according to a new analysis comparing several trials. A study has indeed evaluated the various treatments put in place to relieve sciatica linked to an intervertebral disc which presses on the sciatic nerve (movements, painkillers, infiltrations and surgery). And the long-term benefits would not be dramatic.
Surgery relieves faster, but its benefits do not last
The study in question, published on April 19 in the journal British Medical Journal, is a meta-analysis comparing 24 randomized controlled trials of sciatica treatments considering surgery, nonsurgical approaches, and infiltrations, to see if one method stood out. Verdict? Surgical intervention for the treatment of sciatica due to herniated disc is more effective than non-surgical treatment in reducing pain and disability. Patients who underwent surgery experienced a greater reduction in pain. However, these apparent benefits do not last over time. And no notable effect was observed for medium- and long-term disability. Surgery therefore remains an effective solution only in the short term and non-surgical treatments should be considered first-line.
The intervention proposed only in three cases in France
Contacted on the subject, Dr. Laurent Grange, rheumatologist and member of our committee of experts confirms the non-definitive aspect of surgery in sciatica. As such, he also recalls that the surgical procedure, in addition to having a cost, is never trivial and always carries a risk of complication.
“We know that sciatica heals on its own over time, in more than 90% of cases. In practice, surgery is therefore reserved for 3 specific cases: hyperalgesic sciatica, when despite all the treatments, the patient is “overwhelmed” with pain; when it comes to deficient sciatica, that is to say which creates a significant motor deficit; and when we are faced with what is called the “cauda equina syndrome”, that is to say when the hernia compresses the roots that innervate the perineum, and leads to disorders of the erection in men as well as loss of stool and urine.”
For the rest of sciatica, the rheumatologist confirms the study: the treatment is based on infiltrations, medical care, wearing a lumbar belt… which have just as many long-term effects, without going through the operating table.