Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2016 Nov;25(11):3495-3512.
doi: 10.1007/s00586-015-4148-y. Epub 2015 Jul 26.

Surgery or Physical Activity in the Management of Sciatica: A Systematic Review and Meta-Analysis

Affiliations
Review

Surgery or Physical Activity in the Management of Sciatica: A Systematic Review and Meta-Analysis

Matthew Fernandez et al. Eur Spine J. .

Abstract

Purpose: Previous reviews have compared surgical to non-surgical management of sciatica, but have overlooked the specific comparison between surgery and physical activity-based interventions.

Methods: Systematic review using MEDLINE, CINAHL, Embase and PEDro databases was conducted. Randomised controlled trials comparing surgery to physical activity, where patients were experiencing the three most common causes of sciatica-disc herniation, spondylolisthesis and spinal stenosis. Two independent reviewers extracted pain and disability data (converted to a common 0-100 scale) and assessed methodological quality using the PEDro scale. The size of the effects was estimated for each outcome at three different time points, with a random effects model adopted and the GRADE approach used in summary conclusions.

Results: Twelve trials were included. In the short term, surgery provided better outcomes than physical activity for disc herniation: disability [WMD -9.00 (95 % CI -13.73, -4.27)], leg pain [WMD -16.01 (95 % CI -23.00, -9.02)] and back pain [WMD -12.44 (95 % CI -17.76, -7.09)]; for spondylolisthesis: disability [WMD -14.60 (95 % CI -17.12, -12.08)], leg pain [WMD -35.00 (95 % CI -39.66, -30.34)] and back pain [WMD -20.00 (95 % CI -24.66, -15.34)] and spinal stenosis: disability [WMD -11.39 (95 % CI -17.31, -5.46)], leg pain [WMD, -27.17 (95 % CI -35.87, -18.46)] and back pain [WMD -20.80 (95 % CI -25.15, -16.44)]. Long-term and greater than 2-year post-randomisation results favoured surgery for spondylolisthesis and stenosis, although the size of the effects reduced with time. For disc herniation, no significant effect was shown for leg and back pain comparing surgery to physical activity.

Conclusion: There are indications that surgery is superior to physical activity-based interventions in reducing pain and disability for disc herniation at short-term follow-up only; but high-quality evidence in this field is lacking (GRADE). For spondylolisthesis and spinal stenosis, surgery is superior to physical activity up to greater than 2 years follow-up. Results should guide clinicians and patients when facing the difficult decision of having surgery or engaging in active care interventions. PROSPERO registration number : CRD42013005746.

Keywords: Meta-analysis; Physical activity; Sciatica; Surgery; Systematic review.

Similar articles

See all similar articles

Cited by 5 articles

References

    1. Am J Phys Med Rehabil. 2007 Dec;86(12):957-61 - PubMed
    1. Eur Spine J. 2007 Mar;16(3):329-37 - PubMed
    1. Health Technol Assess. 2011 Nov;15(39):1-578 - PubMed
    1. Occup Environ Med. 2010 Nov;67(11):795-6 - PubMed
    1. Spine (Phila Pa 1976). 2005 Apr 15;30(8):936-43 - PubMed

MeSH terms

LinkOut - more resources

Feedback