The spine journal : official journal of the North American Spine Society
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Review Meta Analysis Comparative Study
Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses.
There are numerous treatment approaches for sciatica. Previous systematic reviews have not compared all these strategies together. ⋯ For the first time, many different treatment strategies for sciatica have been compared in the same systematic review and meta-analysis. This approach has provided new data to assist shared decision-making. The findings support the effectiveness of nonopioid medication, epidural injections, and disc surgery. They also suggest that spinal manipulation, acupuncture, and experimental treatments, such as anti-inflammatory biological agents, may be considered. The findings do not provide support for the effectiveness of opioid analgesia, bed rest, exercise therapy, education/advice (when used alone), percutaneous discectomy, or traction. The issue of how best to estimate the effectiveness of treatment approaches according to their order within a sequential treatment pathway remains an important challenge.