Abstract
Background and ObjectiveCurrently, no satisfactory treatment is available for sciatica caused by herniated discs and/or spinal stenosis. The objective of this study is to assess the value of tumor necrosis factor (TNF)-α inhibitors in the treatment of sciatica.MethodsWithout language restrictions, we searched PubMed, OVID, EMBASE, the Web of Science, the Clinical Trials Registers, the Cochrane Central Register of Controlled Trials and the China Academic Library and Information System. We then performed a systematic review and meta-analysis on the enrolled trials that met the inclusion criteria.ResultsNine prospective randomized controlled trials (RCTs) and two before-after controlled trials involving 531 patients met our inclusion criteria and were included in this study. Our systematic assessment and meta-analysis demonstrated that in terms of the natural course of the disease, compared with the control condition, TNF-α inhibitors neither significantly relieved lower back and leg pain (both p>0.05) nor enhanced the proportion of patients who felt overall satisfaction (global perceived effect (satisfaction)) or were able to return to work (return to work) (combined endpoint; p>0.05) at the short-term, medium-term and long-term follow-ups. In addition, compared with the control condition, TNF-α inhibitors could reduce the risk ratio (RR) of discectomy or radicular block (combined endpoint; RR = 0.51, 95% CI 0.26 to 1.00, p = 0.049) at medium-term follow-up, but did not decrease RR at the short-term (RR = 0.64, 95% CI 0.17 to 2.40, p = 0.508) and long-term follow-ups (RR = 0.64, 95% CI 0.40 to 1.03, p = 0.065).ConclusionThe currently available evidence demonstrated that other than reducing the RR of discectomy or radicular block (combined endpoint) at medium-term follow-up, TNF-α inhibitors showed limited clinical value in the treatment of sciatica caused by herniated discs and/or spinal stenosis.
Highlights
Disk herniation-induced sciatica is one of the most common causes of lower back and leg pain among young adults
Some scholars have stated that non-opioid analgesic agents, discectomy and epidural steroid injection are effective [3]; the opposing opinion indicates that discectomy is only effective for acute neurodynia, and its long-term outcome is not superior to that of conservative treatment [4]
The authors used a weighted mean difference (WMD) technique to pool all of the data together; this is not a standard and conventional method commonly used in metaanalysis [23]; and (3) in addition, we disagree that the authors’ method of pooling together all of the data regarding the outcomes of discectomy, including the data obtained during short-term, medium-term and long-term follow-ups
Summary
Disk herniation-induced sciatica is one of the most common causes of lower back and leg pain among young adults. Previous studies have demonstrated that the outcomes of conservative treatment, such as medication and physical therapy, are similar to the natural course of this disease [1]. Epidural steroid injections can relieve a portion of patients’ pain, they cannot restore the patients’ physical function [2]. Some scholars have stated that non-opioid analgesic agents, discectomy and epidural steroid injection are effective [3]; the opposing opinion indicates that discectomy is only effective for acute neurodynia, and its long-term outcome is not superior to that of conservative treatment [4]. Tumor necrosis factor-alpha (TNF-a) is an inflammatory factor involved in the pathophysiological mechanism underlying disk herniation-induced sciatica [6,7]. The objective of this study is to assess the value of tumor necrosis factor (TNF)-a inhibitors in the treatment of sciatica
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