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The natural history of sciatica: a prospective radiological study
Clinical Radiology
|July 1, 1992
Summary
Conservative treatment, including steroid injections, effectively resolved sciatica in most patients with disc herniation or sequestration. However, disc bulges remained largely unchanged, indicating specific lesion types respond better to treatment.
Area of Science:
- Orthopedics
- Neurosurgery
- Radiology
Background:
- Sciatica is a common condition often caused by intervertebral disc pathologies.
- Conservative management is frequently employed for sciatica, but its effect on disc morphology requires detailed investigation.
Purpose of the Study:
- To prospectively evaluate changes in intervertebral disc morphology following conservative treatment for sciatica.
- To correlate specific disc lesion types with treatment outcomes and resolution of sciatica symptoms.
Main Methods:
- Prospective study involving 165 sciatica patients undergoing lumbar spine computed tomography (CT).
- Disc lesions classified into herniation, sequestration, generalized bulge, and focal bulge.
- Follow-up CT performed after 1 year on 106 patients treated with steroid and local anesthetic injections at the disc/nerve root interface.
Main Results:
- 76% of herniation and sequestration cases showed complete or partial resolution on follow-up CT.
- 82% of generalized or focal disc bulge cases remained unchanged.
- Classical disc herniation in younger patients demonstrated the most significant improvement.
Conclusions:
- Conservative treatment, particularly steroid injections, is effective in resolving sciatica associated with disc herniation and sequestration.
- Disc bulges show limited resolution with this conservative approach.
- Younger patients with classical disc herniation are most likely to experience favorable outcomes.