Evidence map›Paper›PMID 26210309›Full record

SynthesisEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2016

Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis.

Matthew Fernandez, Manuela L Ferreira, Kathryn M Refshauge, Jan Hartvigsen, Isabela R C Silva, Chris G Maher, Bart W Koes, Paulo H Ferreira

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed, 3 pooled it
2.9field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

15 citing papers in PubMed, 3 syntheses or guidelines pooled it, 36 citations in OpenAlex.

  1. How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2023
    Pooled it
  2. Pooled it
  3. Pooled it
  4. Trial
  5. Article
  6. Exploring Values Clarification and Health-Literate Design in Patient Decision Aids: A Qualitative Interview Study.Medical decision making : an international journal of the Society for Medical Decision Making · 2025
    Article
  7. Article
  8. A Decision Aid for Patients Considering Surgery for Sciatica: Codesign and User-Testing With Patients and Clinicians.Health expectations : an international journal of public participation in health care and health policy · 2024
    Article
  9. Review
  10. Article
  11. Article
  12. Article
  13. Review
  14. Back Pain with Leg Pain.Current pain and headache reports · 2017
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 3 countries.

Matthew FernandezFaculty of Health Science, University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 2141, Australia. mfer4234@uni.sydney.edu.au.
Manuela L FerreiraThe George Institute for Global Health, Sydney Medical School, University of Sydney, 321 Kent Street, Sydney, NSW, 2000, Australia.
Kathryn M RefshaugeFaculty of Health Science, University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 2141, Australia.
Jan HartvigsenDepartment of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
Isabela R C SilvaFaculty of Health Science, University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 2141, Australia.
Chris G MaherThe George Institute for Global Health, Sydney Medical School, University of Sydney, 321 Kent Street, Sydney, NSW, 2000, Australia.
Bart W KoesDepartment of General Practice, Erasmus University Medical Centre, P.O. Box 2040, 3000, Rotterdam, The Netherlands.
Paulo H FerreiraFaculty of Health Science, University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 2141, Australia.
University of Sydney · AUThe George Institute for Global Health · AUErasmus University Rotterdam · NLNordisk Institut for Kiropraktik og Klinisk Biomekanik · DK

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposePrevious reviews have compared surgical to non-surgical management of sciatica, but have overlooked the specific comparison between surgery and physical activity-based interventions.

methodsSystematic review using MEDLINE, CINAHL, Embase and PEDro databases was conducted. Randomised controlled trials comparing surgery to physical activity, where patients were experiencing the three most common causes of sciatica-disc herniation, spondylolisthesis and spinal stenosis. Two independent reviewers extracted pain and disability data (converted to a common 0-100 scale) and assessed methodological quality using the PEDro scale. The size of the effects was estimated for each outcome at three different time points, with a random effects model adopted and the GRADE approach used in summary conclusions.

resultsTwelve trials were included. In the short term, surgery provided better outcomes than physical activity for disc herniation: disability [WMD -9.00 (95 % CI -13.73, -4.27)], leg pain [WMD -16.01 (95 % CI -23.00, -9.02)] and back pain [WMD -12.44 (95 % CI -17.76, -7.09)]; for spondylolisthesis: disability [WMD -14.60 (95 % CI -17.12, -12.08)], leg pain [WMD -35.00 (95 % CI -39.66, -30.34)] and back pain [WMD -20.00 (95 % CI -24.66, -15.34)] and spinal stenosis: disability [WMD -11.39 (95 % CI -17.31, -5.46)], leg pain [WMD, -27.17 (95 % CI -35.87, -18.46)] and back pain [WMD -20.80 (95 % CI -25.15, -16.44)]. Long-term and greater than 2-year post-randomisation results favoured surgery for spondylolisthesis and stenosis, although the size of the effects reduced with time. For disc herniation, no significant effect was shown for leg and back pain comparing surgery to physical activity.

conclusionThere are indications that surgery is superior to physical activity-based interventions in reducing pain and disability for disc herniation at short-term follow-up only; but high-quality evidence in this field is lacking (GRADE). For spondylolisthesis and spinal stenosis, surgery is superior to physical activity up to greater than 2 years follow-up. Results should guide clinicians and patients when facing the difficult decision of having surgery or engaging in active care interventions. PROSPERO registration number : CRD42013005746.

Indexed as

Exercise TherapyNeurosurgical ProceduresOrthopedic ProceduresDisability EvaluationHumansIntervertebral Disc DisplacementSciaticaSpinal StenosisSpondylolisthesisMeta-analysisPhysical activitySciaticaSurgerySystematic review

Identifiers

PMID26210309
OpenAlexW1039885137

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.