Prognostic Factors for Non-surgically treated Sciatica patients

Sciatica is characterized by low back-related leg pain and associated disabilities. Diagnosis is based on history and physical examination. The term “sciatica” is widely used despite varying symptom definitions. Prevalence rates range from 2.2% to 34% in different studies.

Sciatica is commonly caused by a herniated lumbar disc. Most patients experience favorable natural improvement, but surgery may be considered if conservative therapy fails. Surgical discectomy offers faster relief from leg pain and perceived recovery compared to prolonged conservative treatment.

However, at the one-year follow-up, pain relief and recovery rates are similar between early surgery and conservative treatment. Optimal patient selection for surgery remains a challenge. High leg pain intensity and greater disability at baseline are potential factors for subsequent surgery.

Identifying prognostic factors is important for predicting the need for early surgery and understanding the clinical course of sciatica.

In 2003, a systematic review reported by literature examined prognostic factors for acute low back pain and sciatica, but only one study focused on sciatica without reporting prognostic factors. Another review in 2011 found no standout prognostic factor for nonsurgically treated sciatica.

To address these limitations, a new systematic review aimed to evaluate all possible prognostic factors for persistent pain, disability, recovery, and surgery in non-surgically treated sciatica patients.

A study reported by literature revealed compelling evidence that high pain intensity in the leg at baseline is a strong predictor of future surgery for sciatica. However, there was no substantial evidence supporting the association of various factors such as age, gender, smoking, prior history of low back pain or sciatica, physical exercise, and specific physical examination findings with surgery or recovery outcomes.

It was observed that the evidence on prognostic factors for non-surgically treated sciatica is limited, and studies in this field demonstrate heterogeneity.

The study’s findings indicate that various factors often attributed with prognostic significance in sciatica, including age, BMI, smoking, and sensory disturbance, do not exhibit any association with the outcome.

This underscores the necessity for additional research in this field. Based on the findings, developing an effective prognostic model for individuals with sciatica may pose challenges, potentially impacting clinical decision-making processes.

Regarding the heterogeneity of the studies and the associations between different factors and prognosis, factors such as age, gender, BMI, smoking, previous sciatica, level of disc herniation, and heaviness of work show no significant association with poor outcome based on strong evidence.

Additionally, our review provided strong evidence suggesting no association between favorable outcome and factors such as physical exercise, pain during coughing/sneezing/straining, pain on sitting, sensory disturbance, motor loss, tendon reflex differences, Kemp’s sign, and finger-floor distance. A systematic review conducted previously focused on prognostic factors in non-surgically treated sciatica.

In systematic reviews, consideration of publication bias is vital. This study took measures to mitigate bias, including conducting a comprehensive search without language restrictions and including studies that focused on single factors.

Predicting the need for surgery in patients with sciatica is challenging due to variations in surgical indications across different settings. Nonetheless, consistent findings in our study revealed that high leg pain intensity strongly predicted the need for surgery.

It is important to acknowledge potential biases such as multiple testing and small sample sizes, which may have influenced the results. Additionally, result variations were influenced by the inclusion of diverse populations, variations in follow-up times, and the combination of different outcome measures.

Drawing definitive conclusions about the lack of effect based on the available evidence requires caution, as it is crucial to differentiate between evidence indicating a lack of effect and the absence of evidence for an effect.

The evidence regarding prognostic factors predicting the outcome in nonsurgically treated sciatica is limited. Studies examining prognostic factors in nonsurgically treated sciatica demonstrate heterogeneity in terms of clinical, methodological, and statistical aspects.

Most evaluated factors do not show an association with the outcome at follow-up. However, there is strong evidence supporting the prediction of subsequent surgery based on high leg pain intensity at baseline.