[Non surgical treatment of disk-related sciatica]

Abstract

The treatment of sciatica due to lumbar disc herniation must be conservative, except if there is severe paralysis or a cauda equina syndrome. First of all, treatment needs bed rest during 15 days, non steroid antiinflammatory drugs and analgesics. In case of failure we propose 2 to 3 epidural injections of corticosteroids. Lumbar brace is often necessary. After 6 weeks of treatment including complete bed rest, radical treatment is proposed, either surgical or percutaneous. If the disc herniation is sequestered or if there is lumbar stenosis, surgery is indicated. In the other cases the choice between chemonucleolysis with chymopapain or percutaneous nucleotomy must be made with the patient informed of the results and complications of the different techniques and according to the results of CT scan or magnetic resonance imaging. Surgery remains efficacious after failure of percutaneous treatment.