Skip to main content
NCBI home page
Brain & Spine logoLink to Brain & Spine
. 2025 Nov 10;5:105870. doi: 10.1016/j.bas.2025.105870

Prognostic factors for treatment success of conservative management and role for physiotherapy in radicular pain caused by a lumbar disc herniation: a systematic review

Felix De Bruyn 1, Shaman Ambaliya 1, Bart Depreitere 1,⁎
PMCID: PMC12657478  PMID: 41321762

Abstract

Introduction

Lumbar disc herniation is a frequent cause of radicular leg pain and has a pronounced impact on the quality of life. While guidelines discommend surgery in the acute phase of the condition, literature on conservative treatment is relatively scarce. In this systematic review, prognostic factors for success of conservative management are investigated as well as the effect of physiotherapy on leg pain.

Methods

We searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Pedro, Web of Science, Scopus, CINAHL, ICTRP, and Clinicaltrials.gov from commencement to September 2022. Following screening 22 reports were included in the analysis and assessed for risk of bias by using the RoB 2 tool for randomized trials and the ROBINS-I tool for prospective cohort studies.

Results

Fifteen papers with moderate to high risk of bias reported on prognostic factors for treatment success following nonsurgical management. Extruded disc morphology was associated with better outcomes in two articles. Severe baseline symptoms and receiving workers compensation were associated with worse outcomes in three and two studies, respectively. Physiotherapy reportedly had a beneficial effect on radicular leg pain in 5 out of 7 studies with low to moderate risk of bias.

Conclusion

Certain physiotherapy actions seem to have value with respect to the relief of radicular symptoms in the conservative management of LDH with radicular pain. Severe baseline symptoms seems to be a risk factor for poor outcome after conservative management. There is a need for high-quality evidence on non-surgical treatments to match the literature on surgical treatment.

Keywords: Lumbar disc herniation, Radicular leg pain, Conservative management, Physiotherapy, Prognosis

Highlights

  • •

    Success of conservative management and effect of physiotherapy in lumbar disc herniation was reviewed in literature.

  • •

    Severe baseline symptoms are a risk factor for poor outcome after conservative management.

  • •

    Certain physiotherapy actions can relieve radicular symptoms in the conservative management of lumbar disc herniations.

1. Introduction

Radicular leg pain originating from nerve root compression by a lumbar disc herniation (LDH), also referred to as sciatica, is a prevalent condition with an annual incidence around 2.2 % and a lifetime prevalence exceeding 30 % in high income countries (Chen et al., 2018; Koes et al., 2007). It has a pronounced impact on the quality of life and is a major cause of work absenteeism.

LDH represents a type of degeneration in the lumbar spine. Jensen et al. reported that smokers and obese patients are at greater risk for developing LDH (Jensen et al., 2019). The natural course of radicular pain due to LDH is usually favorable, with up to 90 % of patients improving spontaneously (Bailey et al., 2020). In addition to reassuring the patient based on the former, the current focus in the non-surgical, i.e. conservative, management of LDH is on comfort by analgesics as well as empowerment and swift resumption of normal activities (Koes et al., 2007). Surgical decompression can be considered if symptoms persist despite conservative management, and guidelines recommend to continue conservative measures for at least 6 weeks before offering the option of surgery in the absence of motor weakness or cauda equina symptoms (van Wambeke et al., 2017, UK, NGC). A vast amount of literature exists on the surgical treatment of LDH, including evidence on prognostic factors for surgical treatment success and on risk of recurrence. This is much less the case concerning conservative management. For instance, one could argue that when prognostic factors for treatment success of conservative management exist and when these would be unfavorable in a given patient, one would not have to wait for at least 6 weeks before considering surgery. Also, studies reporting on the effect of physiotherapy interventions in patients with LDH usually report on disability and overall pain scores with little information on sciatica intensity itself (Singh et al., 2021a). In general, the goal of physiotherapy, or physiotherapy, is to improve mobility, restore function, reduce pain, and prevent further injury by using exercises and a variety of methods based on physical stimuli. Physiotherapy plays an important role in the management of low back pain (van et al., 2017; UK), but its role in alleviating radicular pain is less well documented.

This systematic review aims to find and summarize evidence regarding two topics concerning the conservative treatment of LDH: 1) Do prognostic factors exist that make it more likely that a patient with LDH will have good/excellent functional outcomes after conservative treatment?, and 2) What is the effect of physiotherapy/exercise on the radicular pain in LDH?

2. Methods

2.1. Search strategy

The search strategy included terms referring to sciatica, radicular pain, radiculopathy, lumbosacral spine and intervertebral disc and was developed in collaboration with a medical librarian at KU Leuven. A detailed report of the search strategy can be found in Appendix I. We searched Medline (PubMed), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Pedro, Web of Science, Scopus, CINAHL, ICTRP, and Clinicaltrials.gov from commencement to September 2022. A supplementary search was performed by citation tracking Endnote was used for literature management. Reporting was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) (Moher et al., 2010).

2.2. Selection criteria

After deduplication, titles/abstracts (phase 1) and full texts (phase 2) were screened by two independent authors (FD and SA) using Rayyan software. In case of disagreement a third author (BD) acted as third reviewer. We only selected studies that reported in English language and on radicular leg pain in adults caused by a confirmed lumbar disc herniation. The following additional inclusion criteria were applied for question 1 on prognostic factors: 1) prospective design, 2) a sample size of at least 100 patients, and 3) studies describing prognostic factors for treatment success of non-surgical management. For question 2 on the effect of physiotherapy on radicular pain, we additionally only selected 1) studies with a randomized controlled trial (RCT) design, 2) a sample size of at least 50 patients, and 3) reporting on conventional physiotherapy, such as exercise and manual therapy. Alternative medicine therapies, such as acupuncture, and outdated therapies, such as bed rest, were excluded. Injection therapies and invasive treatments were also excluded. Articles focusing on the role of physiotherapy supplementary to surgery were excluded.

2.3. Risk of bias

Quality assessment of included studies was performed by using the Risk of Bias 2.0 tool for RCTs and the ROBINS-I tool for prospective cohort studies, as recommended by the Cochrane handbook for systematic reviews (Higgins et al., 2021). This was independently executed by FD and SA and disagreements were discussed and resolved among the group of 3 authors.

2.4. Data extraction

Excel was used for data management. We extracted the following study characteristics for both questions: title, author and year, study design, location, number of participants, sex, age group, follow-up period, and treatment received. From the papers concerning prognostic factors, we also extracted the original RCT or cohort since several papers were based on the same original studies. The most frequently reported outcome measures were Visual analogue scale (VAS) for both leg and back pain, Oswestry Disability Index (ODI), straight leg raise test positivity (SLR), and Roland Disability Questionnaire (RDQ). The associations from the articles reporting on prognostic factors were sorted by positive or negative influence. The reported effect of physiotherapy on outcome measures was documented.

3. Results

3.1. Study characteristics

We identified a total of 20,221 records from seven databases. After deduplication, 9596 titles and abstracts were screened and 120 remained for eligibility screening. Finally, 22 articles were included: 15 for the assessment of prognostic factors for good outcome after conservative treatment and 7 for the effect of physiotherapy on radicular pain (Fig. 1). All studies had mixed-sex populations, except for one RCT by Ye et al. (2015), which only included male subjects. All subjects were adults, with most of them between 18 and 65 years of age. Most studies took place in the US, followed by Europe, Scandinavia, and Asia. Only one study was conducted in Africa. All articles were published in English. The length of follow-up ranged from 3 months to 8 years. Study characteristics are outlined in Appendix II (prognostic factors) and III (effect of physiotherapy). A total of 15 reports were included in the search on prognostic factors for treatment success in conservative therapy. Of these reports, 12 were prospective cohort studies, and 3 were RCTs. Several reports on prognostic factors were based on the same studies, with six using data from the SPORT trial (Freedman et al., 2011; Kerr et al., 2015; Olson et al., 2011; Pearson et al., 2012; Rihn et al., 2011; Suri et al., 2015) and 3 from the sciatica trial (Peul et al., 2008a, 2008b; El et al., 2016). Because of the difference in prognostic factors investigated, follow-up periods, and outcome measurements, we included all these reports in the present analysis on prognostic factors. Physiotherapy modalities investigated concerning the second question included symptom-guided exercises, McKenzie therapy, traction, manipulation, spinal mobilization with leg movement exercise and lumbar spine stabilization exercise.

Fig. 1.

Fig. 1

Open in a new tab

Study screening and selection flowchart.

Details of the risk of bias assessment are illustrated in Fig. 2, Fig. 3, Fig. 4. For the reports assessing prognostic factors of conservative therapy, all but one prospective cohort reports had a moderate risk of bias and one a high risk of bias, mainly due to confounding bias. The 3 RCT's were based on the same original study and all had a high risk of bias resulting from outcome measurement bias. The 7 RCT's that assessed physiotherapy measures had an overall low risk of bias, except for 2 studies with a moderate risk of bias due to confounding data and/or missing data.

Fig. 2.

Fig. 2

Open in a new tab

Risk of bias (RoB 2) for the RCT studies on prognostic factors.

Fig. 3.

Fig. 3

Open in a new tab

Risk of bias (ROBINS-I) for the prospective studies on prognostic factors.

Fig. 4.

Fig. 4

Open in a new tab

Risk of bias (RoB 2) for the RCT studies on the role of physiotherapy.

3.2. Prognostic factors for good outcome after conservative management

Five reports found no prognostic factors associated with a good or bad outcome following conservative management (Table 1). The output of the other reports was mixed. Six articles found factors positively associated with a good outcome, and nine reported negative associations. Predictors were related to symptoms at baseline (dominant radicular pain (Azharuddin et al., 2022), positive straight leg raise test (Suri et al., 2015), lower extremity weakness (Azharuddin et al., 2022), back pain and leg pain severity (Kerr et al., 2015; Peul et al., 2008a), disability (Peul et al., 2008a), symptom worsening (Pearson et al., 2012), prior low back pain (Suri et al., 2015) as negative and symptom duration <6 months (Rihn et al., 2011) as positive predictors), MRI characteristics (protrusion as negative (Kerr et al., 2015) and positive (Jensen et al., 2007) predictor, extrusion (Olson et al., 2011; Jensen et al., 2007) and posterolateral location (Suri et al., 2015) as positive predictors), patient factors (workers compensation (Suri et al., 2015; Jensen et al., 2007) and smoking (Suri et al., 2016) as negative predictors, male sex (Suri et al., 2015; Jensen et al., 2007), working at presentation (Kerr et al., 2015), higher education (Olson et al., 2011) and single status (Pearson et al., 2012) as positive predictors and joint problems as both negative (Suri et al., 2015) and positive (Pearson et al., 2012) predictor) and symptom evolution (complete initial resolution as positive predictor (Suri et al., 2016)). A summary of the negative or positive effect per predictor, including effect size (when reported) and GRADE level of certainty is provided in Table 2. The following factors were predictive in more than one study: diagnosis of an extruded nucleus pulposus on MRI was found to be of positive prognostic value in two articles (Kerr et al., 2015; Jensen et al., 2007),evere baseline back pain was associated with worse outcome in two articles (Kerr et al., 2015; Peul et al., 2008a), and receiving workers compensation or being involved in a compensation claim was associated with worse outcome in two studies (Suri et al., 2015; Rasmussen et al., 2008). The above prognostic factors (extrusion as positive factor; severe baseline back pain and workers compensation as negative factors) were not associated with inconsistent findings in the other studies. The other negative or positive prognostic factors described in Table 1 were each proven to be statistically significant in only one report without confirmation in others (Freedman et al., 2011; Olson et al., 2011; Rihn et al., 2011; Peul et al., 2008b; El et al., 2016; Azharuddin et al., 2022; Modic et al., 2005; Suri et al., 2011). All factors were investigated in at least two different reports. Two factors were associated with inconsistent findings: joint problems and protrusion morphology were shown to be of both positive and negative influence in one article each. GRADE certainty of evidence was overall low to very low (Table 2).

Table 1.

Prognostic factors for good outcome in conservative management.

Author and year Positive association found Negative association found Factors investigated
Azharuddin et al., 2022 (Azharuddin et al., 2022) (original study) None Dominant radicular pain, lower extremity weakness Age, gender, occupation, education, marital status, BMI, duration of complaint, type of dominant pain, pain intensity, comorbidity, regular exercise, smoking, non-compliance, ignorance, SLR test, cross SLR test, motor power of lower extremities, sensory functions, reflexes, MRI classification
El et al., 2016 (El et al., 2016) (analysis on Leiden-The Hague Sciatica RCT data (Peul et al., 2007)) None None MRI findings: presence of nerve root compression, level of disc herniation, size of disc herniation, location of disc herniation, morphology of disc herniation, absence of epidural fat adjacent to dural sac or surrounding nerve root sheath, presence of impaired discs on other disc levels, presence of vertebral endplate signal changes at level of herniated disc, presence of Schmorl nodules (herniation of disc into vertebral body endplate) at level of herniated disc
Freedman et al., 2011 (Freedman et al., 2011) (analysis on SPORT trial (Birkmeyer et al., 2002) data) None None Diabetes
Jensen et al., 2007 (Jensen et al., 2007) (original study) Broad-based protrusions, extrusions, male sex None MRI findings: disk contour, location of herniation, nerve root, disk signal, disk height, central stenosis, lateral stenosis, foraminal stenosis
Kerr et al., 2015 (Kerr et al., 2015) (analysis on SPORT trial (Birkmeyer et al., 2002) data) Extruded disc, Working at baseline Severe baseline backpain, protruded disc Sex, smoking, joint problems, depressed, baseline LBP, motor deficit, posterolateral herniation, working status, level of herniation, extrusion, protrusion, sequestered, duration of symptoms
Modic et al., 2005 (Modic et al., 2005) (original study) None None MRI findings: size, type, location, change of herniation size, extrusion, protrusion, sequestered
Olson et al., 2011 (Olson et al., 2011) (analysis on SPORT trial (Birkmeyer et al., 2002) data) Higher educational attainment Lower educational attainment Educational status
Pearson et al., 2012 (Pearson et al., 2012) (analysis on SPORT trial (Birkmeyer et al., 2002) data) Marital status: single, joint problems Worsening baseline symptoms Baseline ODI, sciatica bothersomeness, age, sex, BMI, reflexes, SLR test, joint problems, depressed, comorbidities, missed work, opoid use, prior injections, insurance, litigation, satisfied with symptoms, predominant leg pain, education level, sensory deficit, posterolateral herniation, stomach problems, hypertension, antidepressants use, NSAID use, physiotherapy, lifting at work, receiving workers compensation, level of herniation, protrusion, extrusion, sequestered, duration, smoking, race, marital status, working, income, worsening symptoms at baseline
Peul et al., 2008 (Peul et al., 2008b) (analysis on Leiden-The Hague Sciatica RCT data (Peul et al., 2007)) None None Gender, age, job, housewife, partner, children, smoking, Quetelet index, start sciatica, provoked by sitting, SLR test, crossed leg raising, kemp's sign, Bragard's test, MRI-level herniation, MRI-sequester, preference surgery
Peul et al., 2008 (Peul et al., 2008a) (analysis on Leiden-The Hague Sciatica RCT data (Peul et al., 2007)) None High initial pain and disability scores Gender, age, mentally demanding job, physical job, housewife, start sciatica, coughing, SLR test, crossed leg raising, Kemp's sign, Bragard's test, sensory disturbance, MRI-level herniation, MRI-sequester, preference surgery
Rasmussen et al., 2008 (Rasmussen et al., 2008) (original study) None Workers compensation Compensation claim
Rinh, 2011 (Rihn et al., 2011) (analysis on SPORT trial (Birkmeyer et al., 2002) data) Symptoms less than 6 months Symptoms more than 6 months Symptom duration
Suri et al., 2015 (Suri et al., 2015) (systematic review) None Prior low back pain, positive SLR test, receiving workers compensation, female sex Initial leg pain intensity, initial disability, duration of symptoms, prior LBP, positive SLR test, positive femoral stretch test, initial back pain, female sex, smoking, medical comorbidities, workers compensation, muscle weakness, herniation morphology, duration of symptoms, age
Suri et al., 2011 (Suri et al., 2011) (original study) None None Age
Suri et al., 2016 (Suri et al., 2016) (analysis on SPORT trial (Birkmeyer et al., 2002) data) Posterolateral herniation, complete initial resolution of pain after treatment, other medical comorbidities Smoking, joint problems Early leg pain recovery (within 6 months), age, female, race, education, marital status, BMI, smoking, comorbidities depression smoking, full or part time employment, any compensation, work lifting, high expectation, baseline leg pain bothersomeness, posterolateral herniation, herniation type, herniation level
Open in a new tab

Table 2.

Summary of predictive variables with number of (original) studies investigating their effect, effect size and GRADE certainty of evidence level.

3.2.

Open in a new tab

3.3. Effect of physiotherapy on radicular pain

Seven articles compared conservative treatment with and without physiotherapy regarding disability, functional status, leg pain, back pain, and other outcome measurements. A detailed description of the reported outcomes can be found in Table 3. Five out of seven articles reported a statistically significant beneficial effect of physiotherapy on the course and outcome of the radicular pain and symptoms (Albert and Manniche, 2012; Hossain et al., 2021; Moustafa and Diab, 2013; Santilli et al., 2006; Satpute et al., 2019). There were no inconsistencies across studies. Notably, the studies essentially examined different modalities of physiotherapy.

Table 3.

Effect of physiotherapy on radicular pain.

Author and year Intervention/Control Reported role of treatment GRADE certainty of evidence
Abou-Elroos et al., 2017 (Abou-Elroos et al., 2017) Intervention: Prolonged physiotherapy program for 6 months; Control: early surgery 1) Prolonged physiotherapy for 6 months is beneficial in the treatment of lumbar disc herniation 2) No significant difference between surgery and prolonged physiotherapy in disability and work status 3) Statistically significant better score on Prolo scale for prolonged physiotherapy Moderate
Albert et al., 2012 (Albert and Manniche, 2012) Intervention: symptom-guided exercises, information, and advice to stay active; Control: sham exercises, information, and advice to stay active 1) Statistically significant more improvement in the symptom guided exercise group for global improvement, sick leave, vocational status, root compression signs and patient satisfaction High
Hossain et al., 2021 (Hossain et al., 2021) Intervention: McKenzie manipulative therapy for 12 sessions in 4 weeks; Control: stretching exercise and graded oscillatory mobilization. 1) Statistically significant superior outcomes for the McKenzie approach in outcome for fear avoidance and feeling of abnormal sensation in the leg compared to the control group Moderate
Moustafa et al., 2013 (Moustafa and Diab, 2013) Intervention: lumbar extension traction, hot packs, and inferential therapy; Control: hot packs and interferential therapy 1) statistically significant better results in the traction group with regard to back and leg pain, disability, H-reflex parameters and segmental intervertebral movements Moderate
Santilli et al., 2006 (Santilli et al., 2006) Intervention: active manipulation; Control: simulated manipulation 1) Statistically significant more effect in the active simulation group for acute back pain and sciatica Moderate
Satpute et al., 2009 (Satpute et al., 2019) Intervention: SMWLM exercise and electrotherapy; Control: Exercise and electrotherapy 1) Statistically significant more improvement in the interventional group for leg pain, back pain, disability, SLR ROM, and patient satisfaction Low
Ye et al., 2015 (Ye et al., 2015) Intervention: LLSE and low-power laser; Control: general exercise and low-power laser 1) Both groups showed a statistically significant reduction in VAS and ODI score. 2) The intervention group had statistically significant lower scores for low back pain and ODI at 12 months Very low
Open in a new tab

4. Discussion

The present systematic review underpins the value of physiotherapy in the treatment of sciatica secondary to lumbar disc herniation. Six studies comparing specific physiotherapy actions with conservative control groups without these specified actdions showed a statistically significant better outcome in various outcome variables, irrespective of the type of physiotherapy received. In particular, five studies reported on improvement of radicular symptoms of pain and abnormal sensation resulting from exercise, stabilization exercises, mobilization exercise, McKenzie manipulation and other manipulation, and traction. Since all RCTs involved in this review topic were of high quality with an overall low or moderate risk for bias, the level of evidence can be considered as considerable. Of note, 3 studies compared a specific exercise regimen (i.e. active therapy) versus more general exercises, 2 studies compared a specific manipulation (i.e. passive therapy) with other passive therapies, and 1 study compared McKenzie manipulation (as passive therapy) with exercises (finding superiority for McKenzie). Our findings were consistent with a previous systematic review by Singh et al., in 2021 (Singh et al., 2021b), reporting a significant improvement in pain and disability after physiotherapy in patients with a lumbar disc prolapse and including smaller sample sizes. There was no quantification of outcomes and hence, no comparison between the different types of physiotherapy. The main conclusion is that certain physiotherapy actions seem to have some value with respect to relief of radicular symptoms in the conservative management of LDH with radicular pain.

We found 20 prognostic factors that reportedly affected the possibility of good outcome in conservative management for LDH. Of these, 9 factors were reported to have a positive effect, 9 had a negative effect, and 2 were reported with both positive and negative effect. Only three were demonstrated to be of significance in more than one report. Signs of an extruded disc on MRI were associated with statistically significant better outcomes in two articles. Severe baseline symptoms showed a statistically significant worse outcome in three papers. Receiving workers compensation was associated with a lower chance of good outcome in two studies. Since the impact of the other variables could not be confirmed in more than one study, their evidence level should be considered as low. A qualitative systematic review by Verwoerd et al., in 2013 stated that the majority of the variables they assessed showed no association with treatment outcome (Verwoerd et al., 2013). However, similar to our review, they found evidence for high leg pain intensity at baseline predicting subsequent surgery. This is in line with our finding of worse outcome in patients with severe baseline symptoms. A review by Ashworth et al. did not retrieve any substantial or consistent predictor for treatment success (Ashworth et al., 2011). The authors concluded that the limited number and heterogeneity of the available reports made it impossible to draw firm conclusions on predictors for conservative treatment success. Prognostic factors for good clinical outcomes after discectomy have been studied abundantly. Remarkably, surgical studies found that higher preoperative Oswestry Disability scores, higher preoperative leg pain scores, and higher preoperative back pain scores were associated with better clinical outcomes (Fisher et al., 2004; Silverplats et al., 2010), contrary to severe baseline symptoms being associated with worse outcome in nonsurgical studies reviewed here. This could mean that patients with severe baseline symptoms should preferably get surgery instead of prolonged conservative treatment, which has been literally advocated by Gregory et al., in 2008 (Gregory et al., 2008).

While searching for prognostic factors of treatment success for conservative LDH management, we came across the mentioning of the risk of recurrence after successful conservative treatment by Suri et al. (2016), which is not often reported. They found a recurrence of leg pain at 1 year of 23 %. Another report by Suri et al., in a different conservatively treated LDH cohort, demonstrated a recurrence rate of leg pain of 25 % at 1 year (Suri et al., 2012). Additionally, the 2016 report mentions a rate of recurrence for leg pain of 51 % at three years of follow-up. This is considerably higher than recurrence rates of 2–25 % described at different lengths of follow up following surgical treatment (Krutko et al., 2020; Shepard and Cho, 2019).

The current review was not registered in a systematic review registry, which we acknowledge as a limitation. A substantial limitation associated with the systematic review is the heterogeneity in the reporting of outcome parameters across studies and the subsequent impossibility for quantitative analysis. As a result, findings and conclusions are rater qualitative and descriptive. Furthermore, many reports on prognostic factors were based on the same original cohort studies. This is a limitation since the results represent less data than could be expected based on the number of included papers. Still, we consider our conclusion on the added value of physiotherapy in the nonsurgical treatment of LDH with respect to the relief of radicular symptoms as valid and important. It means that in the acute stage of radicular pain secondary to LDH, when surgical therapy is considered not appropriate according to guidelines, physiotherapy is to be recommended to enhance the potential for recovery without invasive intervention. At the same time, severity of baseline symptoms appears to be a negative predictor of success of conservative management and a positive predictor of success of surgery. This may mean that patients with intense radicular pain and disability may be candidates to be offered a surgical consult when entering the subacute stage. Whether surgery should be offered earlier than 6 weeks in these patients, is a matter to be investigated in future prospective studies. One other conclusion from this review is that there is a need for high-quality evidence on non-surgical treatments to match the literature on surgical treatment.

Declaration of competing interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Bart Depreitere reports was provided by University Hospitals Leuven. Bart Depreitere reports a relationship with University Hospitals Leuven that includes: employment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgment

Krizia Tuand, PhD, was a tremendous help in the development of the search strategy.

Footnotes

This article is part of a special issue entitled: EANS-Lumbar Disc Hernation published in Brain and Spine.

Appendix A

Supplementary data to this article can be found online at https://doi.org/10.1016/j.bas.2025.105870.

Appendix A. Supplementary data

The following is the Supplementary data to this article:

Multimedia component 1
mmc1.docx (31.4KB, docx)

References

  1. Abou-Elroos D.A., El-Toukhy M.A.E., Nageeb G.S., Dawood E.A., Abouhashem S. Prolonged physiotherapy versus early surgical intervention in patients with lumbar disk herniation: Short-term outcomes of clinical randomized trial. Asian Spine J. 2017;11(4):531–537. doi: 10.4184/asj.2017.11.4.531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Albert H.B., Manniche C. The efficacy of systematic active conservative treatment for patients with severe sciatica: a single-blind, randomized, clinical, controlled trial. Spine. 2012;37(7):531–542. doi: 10.1097/BRS.0b013e31821ace7f. [DOI] [PubMed] [Google Scholar]
  3. Ashworth J., Konstantinou K., Dunn K.M. Prognostic factors in non-surgically treated sciatica: a systematic review. BMC Muscoskelet. Disord. 2011;12:208. doi: 10.1186/1471-2474-12-208. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Azharuddin A., Aryandono T., Magetsari R., Dwiprahasto I. Predictors of the conservative management outcomes in patients with lumbar herniated nucleus pulposus: a prospective study in Indonesia. Asian J. Surg. 2022;45(1):277–283. doi: 10.1016/j.asjsur.2021.05.015. [DOI] [PubMed] [Google Scholar]
  5. Bailey C.S., Rasoulinejad P., Taylor D., Sequeira K., Miller T., Watson J., et al. Surgery versus conservative care for persistent Sciatica lasting 4 to 12 months. N. Engl. J. Med. 2020;382(12):1093–1102. doi: 10.1056/NEJMoa1912658. [DOI] [PubMed] [Google Scholar]
  6. Birkmeyer N.J., Weinstein J.N., Tosteson A.N., Tosteson T.D., Skinner J.S., Lurie J.D., Deyo R., Wennberg J.E. Design of the Spine Patient Outcomes Research Trial (SPORT) Spine. 2002;27(12):1361–1372. doi: 10.1097/00007632-200206150-00020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Chen B.L., Guo J.B., Zhang H.W., Zhang Y.J., Zhu Y., Zhang J., et al. Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis. Clin. Rehabil. 2018;32(2):146–160. doi: 10.1177/0269215517719952. [DOI] [PubMed] [Google Scholar]
  8. El Barzouhi A., Verwoerd A.J., Peul W.C., Verhagen A.P., Lycklama À., Nijeholt G.J., Van der Kallen B.F., et al. Prognostic value of magnetic resonance imaging findings in patients with sciatica. J. Neurosurg. Spine. 2016;24(6):978–985. doi: 10.3171/2015.10.SPINE15858. [DOI] [PubMed] [Google Scholar]
  9. Fisher C., Noonan V., Bishop P., Boyd M., Fairholm D., Wing P., et al. Outcome evaluation of the operative management of lumbar disc herniation causing sciatica. J. Neurosurg. 2004;100(4 Suppl. Spine):317–324. doi: 10.3171/spi.2004.100.4.0317. [DOI] [PubMed] [Google Scholar]
  10. Freedman M.K., Hilibrand A.S., Blood E.A., Zhao W., Albert T.J., Vaccaro A.R., et al. The impact of diabetes on the outcomes of surgical and nonsurgical treatment of patients in the spine patient outcomes research trial. Spine. 2011;36(4):290–307. doi: 10.1097/BRS.0b013e3181ef9d8c. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Gregory D.S., Seto C.K., Wortley G.C., Shugart C.M. Acute lumbar disk pain: navigating evaluation and treatment choices. Am. Fam. Physician. 2008;78(7):835–842. [PubMed] [Google Scholar]
  12. Higgins J.P., Thomas J., Chandler J., Cumpston M., Li T., Page M.J., Welch V.A. 2021. Cochrane Handbook for Systematic Reviews of Interventions Cochrane. Available from: training.cochrane.org/handbook. [Google Scholar]
  13. Hossain M.A., Jahid I.K., Hossain M.F., Uddin Z., Kabir M.F., Hossain K.M.A., et al. Efficacy of mckenzie manipulative therapy on pain, functional activity and disability for lumbar disc herniation. Open Sports Sci. J. 2021;14(1):14–24. [Google Scholar]
  14. Jensen T.S., Albert H.B., Sorensen J.S., Manniche C., Leboeuf-Yde C. Magnetic resonance imaging findings as predictors of clinical outcome in patients with sciatica receiving active conservative treatment. J. Manip. Physiol. Ther. 2007;30(2):98–108. doi: 10.1016/j.jmpt.2006.12.004. [DOI] [PubMed] [Google Scholar]
  15. Jensen R.K., Kongsted A., Kjaer P., Koes B. Diagnosis and treatment of sciatica. Br. Med. J. 2019;367 doi: 10.1136/bmj.l6273. [DOI] [PubMed] [Google Scholar]
  16. Kerr D., Zhao W., Lurie J.D. What are long-term predictors of outcomes for Lumbar disc herniation? A randomized and observational Study. Clin. Orthop. Relat. Res. 2015;473(6):1920–1930. doi: 10.1007/s11999-014-3803-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Koes B.W., van Tulder M.W., Peul W.C. Diagnosis and treatment of sciatica. Br. Med. J. 2007;334(7607):1313–1317. doi: 10.1136/bmj.39223.428495.BE. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Krutko A.V., Sanginov A.J., Baykov E.S. Predictors of treatment success following limited discectomy with annular closure for Lumbar disc herniation. Int. J. Spine Surg. 2020;14(1):38–45. doi: 10.14444/7005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Modic M.T., Obuchowski N.A., Ross J.S., Brant-Zawadzki M.N., Grooff P.N., Mazanec D.J., et al. Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. Radiology. 2005;237(2):597–604. doi: 10.1148/radiol.2372041509. [DOI] [PubMed] [Google Scholar]
  20. Moher D., Liberati A., Tetzlaff J., Altman D.G. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int. J. Surg. 2010;8(5):336–341. doi: 10.1016/j.ijsu.2010.02.007. [DOI] [PubMed] [Google Scholar]
  21. Moustafa I.M., Diab A.A. Extension traction treatment for patients with discogenic lumbosacral radiculopathy: a randomized controlled trial. Clin. Rehabil. 2013;27(1):51–62. doi: 10.1177/0269215512446093. [DOI] [PubMed] [Google Scholar]
  22. Olson P.R., Lurie J.D., Frymoyer J., Walsh T., Zhao W., Morgan T.S., et al. Lumbar disc herniation in the Spine Patient Outcomes Research Trial: does educational attainment impact outcome? Spine. 2011;36(26):2324–2332. doi: 10.1097/BRS.0b013e31820bfb9a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Pearson A., Lurie J., Tosteson T., Zhao W., Abdu W., Mirza S., et al. Who should have surgery for an intervertebral disc herniation? Comparative effectiveness evidence from the spine patient outcomes research trial. Spine. 2012;37(2):140–149. doi: 10.1097/BRS.0b013e3182276b2b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Peul W.C., van Houwelingen H.C., van den Hout W.B., Brand R., Eekhof J.A.H., Tans J.T.J., Thomeer R.T.W.M., Koes B.W., Leiden-The Hague Spine Intervention Prognostic Study Group Surgery versus prolonged conservative treatment for sciatica. N. Engl. J. Med. 2007;356(22):2245–2256. doi: 10.1056/NEJMoa064039. [DOI] [PubMed] [Google Scholar]
  25. Peul W.C., Brand R., Thomeer R., Koes B.W. Influence of gender and other prognostic factors on outcome of sciatica. Pain. 2008;138(1):180–191. doi: 10.1016/j.pain.2007.12.014. [DOI] [PubMed] [Google Scholar]
  26. Peul W.C., Brand R., Thomeer R., Koes B.W. Improving prediction of "inevitable" surgery during non-surgical treatment of sciatica. Pain. 2008;138(3):571–576. doi: 10.1016/j.pain.2008.02.011. [DOI] [PubMed] [Google Scholar]
  27. Rasmussen C., Leboeuf-Yde C., Hestbaek L., Manniche C. Poor outcome in patients with spine-related leg or arm pain who are involved in compensation claims: a prospective study of patients in the secondary care sector. Scand. J. Rheumatol. 2008;37(6):462–468. doi: 10.1080/03009740802241709. [DOI] [PubMed] [Google Scholar]
  28. Rihn J.A., Hilibrand A.S., Radcliff K., Kurd M., Lurie J., Blood E., et al. Duration of symptoms resulting from lumbar disc herniation: effect on treatment outcomes: analysis of the Spine Patient Outcomes Research Trial (SPORT) J. Bone. Joint. Surg. Am. 2011;93(20):1906–1914. doi: 10.2106/JBJS.J.00878. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Santilli V., Beghi E., Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006;6(2):131–137. doi: 10.1016/j.spinee.2005.08.001. [DOI] [PubMed] [Google Scholar]
  30. Satpute K., Hall T., Bisen R., Lokhande P. The effect of spinal mobilization with leg movement in patients with lumbar Radiculopathy-A double-blind randomized controlled trial. Arch. Phys. Med. Rehabil. 2019;100(5):828–836. doi: 10.1016/j.apmr.2018.11.004. [DOI] [PubMed] [Google Scholar]
  31. Shepard N., Cho W. Recurrent lumbar disc herniation: a review. Glob. Spine J. 2019;9(2):202–209. doi: 10.1177/2192568217745063. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Silverplats K., Lind B., Zoëga B., Halldin K., Rutberg L., Gellerstedt M., et al. Clinical factors of importance for outcome after lumbar disc herniation surgery: long-term follow-up. Eur. Spine J. 2010;19(9):1459–1467. doi: 10.1007/s00586-010-1433-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Singh V., Malik M., Kaur J., Kulandaivelan S., Punia S. A systematic review and meta-analysis on the efficacy of physiotherapy intervention in management of lumbar prolapsed intervertebral disc. Int. J. Health Sci. 2021;15(2):49–57. [PMC free article] [PubMed] [Google Scholar]
  34. Singh V., Malik M., Kaur J., Kulandaivelan S., Punia S. A systematic review and meta-analysis on the efficacy of physiotherapy intervention in management of lumbar prolapsed intervertebral disc. Int. J. Health Sci. 2021;15(2):49–57. [PMC free article] [PubMed] [Google Scholar]
  35. Suri P., Hunter D.J., Jouve C., Hartigan C., Limke J., Pena E., et al. Nonsurgical treatment of lumbar disk herniation: are outcomes different in older adults? J. Am. Geriatr. Soc. 2011;59(3):423–429. doi: 10.1111/j.1532-5415.2011.03316.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Suri P., Rainville J., Hunter D.J., Li L., Katz J.N. Recurrence of radicular pain or back pain after nonsurgical treatment of symptomatic lumbar disk herniation. Arch. Phys. Med. Rehabil. 2012;93(4):690–695. doi: 10.1016/j.apmr.2011.11.028. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Suri P., Carlson M.J., Rainville J. Nonoperative treatment for lumbosacral radiculopathy: what factors predict treatment failure? Clin. Orthop. Relat. Res. 2015;473(6):1931–1939. doi: 10.1007/s11999-014-3677-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Suri P., Pearson A.M., Scherer E.A., Zhao W., Lurie J.D., Morgan T.S., et al. Recurrence of pain after usual nonoperative care for symptomatic lumbar disk herniation: analysis of data from the spine patient outcomes research trial. Pm r. 2016;8(5):405–414. doi: 10.1016/j.pmrj.2015.10.016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. National Guideline Center UK. Evidence review for pharmacological management of Sciatica: low back pain and Sciatica in over 16s: assessment and management: evidence review A. 2020 Available online: https://pubmed.ncbi.nlm.nih.gov/33090751/. (Accessed 20 March 2021). [PubMed]
  40. van Wambeke P., Desomer A., Ailliet L., Berquin A., Demoulin C., Depreitere B., Dewachter J., Dolphens M., Forget P., Fraselle V., et al. Belgian Health Care Knowledge Centre (KCE); Brussels, Belgium: 2017. Low Back Pain and Radicular Pain: Evaluation and Management; Good Clinical Practice (GCP) KCE Reports 287. D/2017/10.273/36. [Google Scholar]
  41. Verwoerd A.J.H., Luijsterburg P.A.J., Lin C.-W.C., Jacobs W.C.H., Koes B.W., Verhagen A.P. Systematic review of prognostic factors predicting outcome in non-surgically treated patients with sciatica. Eur. J. Pain. 2013;17(8):1126–1137. doi: 10.1002/j.1532-2149.2013.00301.x. [DOI] [PubMed] [Google Scholar]
  42. Ye C., Ren J., Zhang J., Wang C., Liu Z., Li F., et al. Comparison of lumbar spine stabilization exercise versus general exercise in young male patients with lumbar disc herniation after 1 year of follow-up. Int. J. Clin. Exp. Med. 2015;8(6):9869–9875. [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Multimedia component 1
mmc1.docx (31.4KB, docx)

Articles from Brain & Spine are provided here courtesy of Elsevier

RESOURCES