[Disc herniation-induced sciatica: medical or surgical treatment?].
Radiculopathy is a common condition, characterized by a spontaneous regression: in 95 percent of patients, it resolves without surgery, within 1 to 12 months. To shorten the course of this disease, enable patients to resume social and professional activities and avoid chronicity, several therapeutic solutions have been assessed. Based on scientific evidence supporting effectiveness, physicians may prescribe analgesics, NSAID and epidural infiltrations, which probably relieve the pain and improve the quality of life without really modifying the mid-term prognosis. Following a specialized physical, social and professional assessment, surgery may be offered to patients who keep experiencing radicular (and not lumbar) pain. The complication rate is approximately 1 to 3 percent. The effectiveness of surgery is well established, especially with an improved recovery time (50 percent as compared to medical treatment). However, the superiority of a particular surgical technique has not been demonstrated. To date, we are still lacking evidence to demonstrate the effectiveness of percutaneous techniques in good methodological conditions. Finally, confinement to bed, cortisone administered per os or IV, localized spinal manipulations, corsets, vertebral tractions and physiotherapy have no demonstrated impact on the course of sciatica.
Legrand
Erick
E
Service de rhumatologie, CHU Angers, Angers. erlegrand@chu-angers.fr
Hoppé
Emmanuel
E
Bouvard
Béatrice
B
Masson
Charles
C
Audran
Maurice
M
D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications*; D012585:Sciatica / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*