Patients with sciatica still experience pain and disability 5years after surgery: A systematic review with meta-analysis of cohort studies.

Abstract

The clinical course of patients with sciatica is believed to be favourable, but there is conflicting evidence on the postoperative course of this condition. We aimed to investigate the clinical course of sciatica following surgery. An electronic search was conducted on MEDLINE, EMBASE and CINAHL from inception to April 2015. We screened for prospective cohort studies investigating pain or disability outcomes for patients with sciatica treated surgically. Fractionalpolynomial regression analysis was used to generate pooled means and 95% confidence intervals (CI) of pain and disability up to 5years after surgery. Estimates of pain and disability (converted to a 0-100scale) were plotted over time, from inception to last available follow-up time. Forty records (39 cohort studies) were included with a total of 13,883 patients with sciatica. Before surgery, the pooled mean leg pain score was 75.2 (95% CI 68.1-82.4) which reduced to 15.3 (95% CI 8.5-22.1) at 3months. Patients were never fully recovered in the long-term and pain increased to 21.0 (95% CI 12.5-29.5) at 5years. The pooled mean disability score before surgery was 55.1 (95% CI 52.3-58.0) and this decreased to 15.5 (95% CI 13.3-17.6) at 3 months, and further reduced to 13.1 (95% CI 10.6-15.5) at 5years. Although surgery is followed by a rapid decrease in pain and disability by 3months, patients still experience mild to moderate pain and disability 5years after surgery. WHAT DOES THIS REVIEW ADD?: This review provides a quantitative summary of the postoperative course of patients with sciatica. Patients with sciatica experienced a rapid reduction in pain and disability in thefirst 3months, but still had mild to moderate symptoms 5years after surgery. Although no significant differences were found, microdiscectomy showed larger improvements compared to other surgical techniques.