Efficacy of Active Conservative Treatment for Patients With Acute Sciatica
Abstract
Background: The clinical sign of sciatica has been recognized since ancient times. Currently believed to arise from a disorder of the nerve root, the sign is known as lumbosacral radicular, nerve root compromise, nerve root pain, and nerve root entrapment or irritation. Patients with a lumbosacral radicular syndrome are mostly treated conservatively in 612 weeks (acute and subacute phase). Sciatica affects many patients who are commonly treated in primary health care settings, but a small proportion of patients are referred to secondary care and may eventually undergo surgery. One of the possible causes of sciatica is a spinal disc herniation pressing on one of the sciatic nerve roots. Objective: To investigate the efficacy of conservative treatment for the management of patients with sciatica. Patients and Methods: This study was carried out from 1st September 2008 to 30th September, 2009 in the Department of Orthopedics, Social Security Teaching Hospital, Lahore. The selection criteria consisted of hundred patients aged 2060 years, radicular pain of dermatomal distribution to the knee or below in one or both legs and acute sciatica. Patients were excluded if they had previous back surgery, spinal tumors, pregnancy, or an inability to follow the rehabilitation protocol due to concomitant disease such as depression or heart failure. Sciatica is mainly diagnosed by history taking and physical examination. Patients were followed for one year. Results: There were 85 (85%) males and 15 (15%) females with ratio 5.6:1. The baseline treatment adviced to all patients included NSAIDs for short periods, skeletal muscle relaxant, anti-depressant, tapering course of prednisolone: 60 mg for 3 days, 40 mg for 3 days and 20 mg for 3 days, bed rest for 5-7 days and later activity and physical therapy. At 2nd to 3rd weeks epidural steroids were also additionally injected in 25 patients. At 12 weeks follow-up (1st follow-up) 60% patients including 25 patients with additional epidural steroids had no low back pain or radiating pain, were able to return to their routine life with special attention to back care and posture and SLR became negative. 25% patients had expressed improvement but with recurrence of symptoms, although the pain intensity decreased. 15% patients had intractable pain. MRI for lumbosacral spine was done. Ten patients had prolapsed intervertebral disc (PID) L5-S1, 3 patients had PID L4-L5, L5-S1 and 2 patients had PID L4-L5. Conclusion: To treat acute sciatica, active conservative treatment was effective, speed patients recovery, rates of return to work and activities of daily living. It was also useful for patients who had symptoms and clinical findings that would normally qualify them for surgery.
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