Recognising value

Sciatica is a common condition. How much better is surgery at relieving pain and disability than non-surgical treatments or steroid injections? Liu and colleagues conducted a systematic review and meta-analysis to answer this question (doi:10.1136/bmj-2022-070730).1 The certainty of the evidence is low, but at least in the medium term discectomy seems better than non-surgical treatments or steroid injections for reducing leg pain and disability. But the differences between groups lessened over time. Editorialists Annina Schmid and colleagues warn against extrapolating these results to patients in primary care settings, most of whom recover in a few months (doi:10.1136/bmj.p791).2 The value of surgery is mainly confined to patients referred to secondary care with clear discogenic sciatica when rapid pain relief is a priority. For those patients, the results of this review “challenge the stepped care approach that offers the least invasive options first to everyone with sciatica.”Another study has a clearer answer….
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