Sciatica affects up to 40% of people in their lifetime  and can be extremely painful and debilitating. Those with sciatica experience pain or numbness in their lower back, buttock, leg, or foot. This can also be caused by a lumbar herniated disc, degenerative disc disease, lumbar stenosis or spondylolisthesis . Symptoms can include: dull pain, numbness, tingling or stabbing pain, electric shock-like feelings, and throbbing heat . These symptoms may occur for hours; however, some may suffer from persistent sciatica lasting weeks, months or years .
There are two treatment options for sciatica: conservative or surgical. The former entails pain relief medications, epidural injections, electrical stimulation, acupuncture, hot and cold therapy, chiropractic care, and/or physical therapy, among others . On the other hand, a more invasive approach involves surgical interventions such as a discectomy or laminectomy .
Given that 95% of patients with disc-related sciatica show no symptoms after one to twelve months without surgical intervention , the conservative approach is generally the first treatment option considered for the first six to eight weeks . One of the most popular forms of conservative care treatment is physical therapy. A study conducted by Jewell and Riddle in 2005 found that of 1,804 patients with sciatica, 26% of patients had “a meaningful improvement in physical health” after undergoing physical therapy . The study also found that patients who received joint mobility interventions or general exercise fared better than those who received spasm reduction interventions . Another study found that those who received physical therapy showed greater improvement rates than those who did not . A third study found improvement in 70% of patients with sciatica who received physical therapy at the 12-month mark . While there is mixed evidence on the overall effectiveness of physical therapy, there is growing evidence of the positive effects of physical therapy as a treatment for patients with sciatica.
However, discectomy or laminectomy surgeries are an effective option as well and have been shown to reduce recovery time by about 50% . Furthermore, the rate of surgical interventions has increased over the last decade although these results vary among countries . Surgery is required when the pain is opioid resistant, there is altered bladder function, or progressive muscle weakness, although these signs are rare . More typically, surgery is conducted to provide more rapid pain relief .
Whether surgery or a more conservative intervention is a better treatment approach for persistent sciatica is still being investigated. The studies on this subject show mixed results. In a study of 283 patients in 2008, Peul and colleagues found that early surgical intervention resulted in more rapid pain relief than those who received conservative care; however, there was no difference in outcomes at the one or two-year marks . Another study found that there was no difference among the two treatments at the five-year mark . Furthermore, in 2006, Osterman and colleagues found no significant difference at the two-year mark between surgical intervention and conservative care in back or leg pain, health-related quality of life, or subjective disability . They did find moderate evidence for a short-term difference in pain relief in those who received a discectomy . These findings indicate that there may be some evidence for short-term pain relief for those who undergo early surgical intervention, but the long-term effects of the conservative care approach appear similar to those of surgery.
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