Conservative combination therapy of sciatica due to lumbar disc herniation with mechanical physiotherapy (McKenzie), gabapentin, and transforaminal epidural injections

Abstract

Treatment of sciatica due to lumbar disc herniation can be surgical or conservative. Conservative management has been described to be effective in 90% of patients; however, in most studies no consistent treatment concept was used. In the present study, we evaluated the effect of acombined nonsurgical management (McKenzie physiotherapy, gabapentin, and periradicular injections) in 40patients during a10-day inpatient treatment. In addition to the neuro-orthopedic examination, pain severity at rest and after walking were assessed. The Oswestry pain disability scale, the pain severity scale, and the painDETECT scale were examined to assess neuropathic pain components. The duration of incapacity for work and the requirement of alater surgery were recorded. Examinations were performed on the day of admission, on days3, 6, 10, and84, 3months after discharge. During conservative treatment, acontinuous reduction of pain and an improvement of the straight leg raise test as well as finger-to-floor distance could be documented. As the three treatment options were introduced with atime delay, it could be demonstrated that all significantly contributed to the improvement. All treatments were tolerated without side-effects and persistent improvement after 12weeks. On admission, 32% of patients revealed aneuropathic pain component which decreased to 7% at the follow-up. A total of 28patients showed impaired muscle strength on admission, which decreased to 7patients on follow-up. Electromyography revealed pathological results in 70% of patients examined. Asignificant improvement of quality of life (Oswestry Disability Index [ODI]) could be observed and the patients returned to work after 5.8weeks. Only 3/40patients required surgical management due to persistent pain. The combined nonsurgical operative treatment program is effective and well tolerated.