Abstract
Patients with a lumbosacral radicular syndrome are mostly treated conservatively first. The effect of the conservative treatments remains controversial. To assess the effectiveness of conservative treatments of the lumbosacral radicular syndrome (sciatica). Relevant electronic databases and the reference lists of articles up to May 2004 were searched. Randomised clinical trials of all types of conservative treatments for patients with the lumbosacral radicular syndrome selected by two reviewers. Two reviewers independently assessed the methodological quality and the clinical relevance. Because the trials were considered heterogeneous we decided not to perform a meta-analysis but to summarise the results using the rating system of levels of evidence. Thirty trials were included that evaluated injections, traction, physical therapy, bed rest, manipulation, medication, and acupuncture as treatment for the lumbosacral radicular syndrome. Because several trials indicated no evidence of an effect it is not recommended to use corticosteroid injections and traction as treatment option. Whether clinicians should prescribe physical therapy, bed rest, manipulation or medication could not be concluded from this review. At present there is no evidence that one type of treatment is clearly superior to others, including no treatment, for patients with a lumbosacral radicular syndrome.
Similar content being viewed by others
References
Berry H, Hutchinson DR (1988) Tizanidine and ibuprofen in acute low-back pain: results of a double-blind multicentre study in general practice. J Int Med Res 16:83–91
Borms T (1988) Comparison of injectable formulations of tiaprofenic acid and ketoprofen in acute lumbar sciatica. Single-blind randomised trial. Drugs 35(Suppl 1):85–7
Buchner M, Zeifang F, Brocai DR, Schiltenwolf M (2000) Epidural corticosteroid injection in the conservative management of sciatica. Clin Orthop 375:149–56
Burton AK, Tillotson KM, Cleary J (2000) Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation. Eur Spine J 9:202–207
Bush K, Hillier S (1991) A controlled study of caudal epidural injections of triamcinolone plus procaine for the management of intractable sciatica. Spine 16:572–575
Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St-Pierre A, Truchon R, Parent F, Levesque J, Bergeron V, Montminy P, Blanchette C (1997) Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 336:1634–1640
Coxhead CE, Inskip H, Meade TW, North WR, Troup JD (1981) Multicentre trial of physiotherapy in the management of sciatic symptoms. Lancet 1:1065–1068
Cuckler JM, Bernini PA, Wiesel SW, Booth RE Jr, Rothman RH, Pickens GT (1985) The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study. J Bone Joint Surg Am 67:63–66
Dickersin K, Rennie D (2003) Registering clinical trials. Jama 290:516–523
Dickersin K, Manheimer E, Wieland S, Robinson KA, Lefebvre C, McDonald S (2002) Development of the cochrane collaboration’s CENTRAL register of controlled clinical trials. Eval Health Prof 25:38–64
Dilke TF, Burry HC, Grahame R (1973) Extradural corticosteroid injection in management of lumbar nerve root compression. Br Med J 2:635–637
Duplan B, Cabanel G, Piton JL, Grauer JL, Phelip X (1983) Acupuncture et lombosciatique a la phase aigue. Etude en double aveugle de trente cas (Acupuncture and sciatica in the acute phase. Double-blind study of 30 cases) . Sem Hop 59:3109–3114
Health Council of the Netherlands (1999) Management of the lumbosacral radicular syndrome (sciatica). The Hague, publication no. 1999/18
Helliwell M, Robertson JC, Ellis RM (1985) Outpatient treatment of low back pain and sciatica by a single extradural corticosteriod injection. Br J Clin Pract 39:228–231
Higgins JPT, Green S (eds) (2005) Cochrane handbook for systematic reviews of interventions 4.2.5 (updated May 2005). In: The Cochrane Library, Issue 3. Wiley, Chichester
Hofstee DJ, Gijtenbeek JM, Hoogland PH, van Houwelingen HC, Kloet A, Lotters F, Tans JT (2002) Westeinde sciatica trial: randomized controlled study of bed rest and physiotherapy for acute sciatica. J Neurosurg 96:45–49
Karppinen J, Malmivaara A, Kurunlahti M, Kyllonen E, Pienimaki T, Nieminen P, Ohinmaa A, Tervonen O, Vanharanta H (2001) Periradicular infiltration for sciatica: a randomized controlled trial. Spine 26:1059–1067
Klenerman L, Greenwood R, Davenport HT, White DC, Peskett S (1984) Lumbar epidural injections in the treatment of sciatica. Br J Rheumatol 23:35–38
Landis JR, Koch GG (1977) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 33:363–374
Larsson U, Choler U, Lidstrom A, Lind G, Nachemson A, Nilsson B, Roslund J (1980) Auto-traction for treatment of lumbago-sciatica. A multicentre controlled investigation. Acta Orthop Scand 51:791–798
Lidström A, Zachrisson M (1970) Physical therapy on low back pain and sciatica. An attempt at evaluation. Scand J Rehabil Med 2:37–42
Ljunggren AE, Weber H, Larsen S (1984) Autotraction versus manual traction in patients with prolapsed lumbar intervertebral discs. Scand J Rehabil Med 16:117–124
Ljunggren AE, Walker L, Weber H, Amundsen T (1992) Manual traction versus isometric exercises in patients with herniated intervertebral lumbar discs. Physiother Theory Pract 8:207–213
Mathews JA, Hickling J (1975) Lumbar traction: a double-blind controlled study for sciatica. Rheumatol Rehabil 14:222–225
Mathews JA, Mills SB, Jenkins VM, Grimes SM, Morkel MJ, Mathews W, Scott CM, Sittampalam Y (1987) Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections. Br J Rheumatol 26:416–423
Mens JMA, Chavannes AW, Koes BW, Lubbers WJ, Ostelo RWJG, Spinnewijn WEM, Kolnaar BGM (2005) NHG-Standaard lumbosacraal radiculair syndroom (NHG-guideline lumbosacral radicular syndrome). Huisarts en Wetenschap 48:171–178
Ostelo RWJG, de Vet HCW, van Tulder MW, Kerckhoffs MR, Leffers P, Wadell G (2002) Rehabilitation after lumbar disc surgery (Protocol for a cochrane review), The Cochrane Library
Reust P, Chantraine A, Vischer TL (1988) Traitement par tractions mecaniques des lombosciatalgies avec ou sans deficit neurologique. Une etude en “double aveugle” (Treatment of lumbar sciatica with or without neurological deficit using mechanical traction. A double-blind study). Schweiz Med Wochenschr 118:271–274
Ridley MG, Kingsley GH, Gibson T, Grahame R (1988) Outpatient lumbar epidural corticosteroid injection in the management of sciatica. Br J Rheumatol 27:295–299
Robinson KA, Dickersin K (2002) Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using PubMed. Int J Epidemiol 31:150–153
Rogers P, Nash T, Schiller D, Norman J (1992) Epidural steriods for sciatica. Pain Clin 5:67–72
Schork MA (2003) Publication bias and meta analysis. J Hypertens 21:243–245
Snoek W, Weber H, Jorgensen B (1977) Double blind evaluation of extradural methyl prednisolone for herniated lumbar discs. Acta Orthop Scand 48:635–641
Stam J (1996) Consensus over diagnostiek en behandeling van het lumbosacrale radiculaire syndroom (Consensus in diagnosing and treatment of the lumbosacral radicular syndrome). Ned Tijdschr Geneeskd 140:2621–2627
Thomas E, Cyteval C, Abiad L, Picot MC, Taourel P, Blotman F (2003) Efficacy of transforaminal versus interspinous corticosteroid injectionin discal radiculalgia—a prospective, randomised, double-blind study. Clin Rheumatol 22:299–304
Van Tulder M, Furlan A, Bombardier C, Bouter L (2003) Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine 28:1290–1299
Verhagen AP, de Vet HC, de Bie RA, Boers M, van den Brandt PA (2001) The art of quality assessment of RCTs included in systematic reviews. J Clin Epidemiol 54:651–654
Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, Knipschild PG (1998) The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 51:1235–1241
Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA (1999) Lack of effectiveness of bed rest for sciatica. N Eng J Med 340:418–423
Vroomen PC, de Krom MC, Slofstra PD, Knottnerus JA (2000) Conservative treatment of sciatica: a systematic review. J Spinal Disord 13:463–469
Weber H (1973) Traction therapy in sciatica due to disc prolapse (does traction treatment have any positive effect on patients suffering from sciatica caused by disc prolapse)? J Oslo City Hosp 23:167–176
Weber H (1983) Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine 8:131–140
Weber H, Holme I, Amlie E (1993) The natural course of acute sciatica with nerve root symptoms in a double-blind placebo-controlled trial evaluating the effect of piroxicam. Spine 18:1433–1438
Weber H, Ljunggren AE, Walker L (1984) Traction therapy in patients with herniated lumbar intervertebral discs. J Oslo City Hosp 34:61–70
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Luijsterburg, P.A.J., Verhagen, A.P., Ostelo, R.W.J.G. et al. Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. Eur Spine J 16, 881–899 (2007). https://doi.org/10.1007/s00586-007-0367-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-007-0367-1