Modern Interventional and Treatment Approaches for Sciatica: Determining the Best Strategy Based on a Comprehensive Literature Review

Abstract

Sciatica is a prevalent clinical condition affecting approximately 2–5% of the global population, often resulting in significant disability and a substantial socioeconomic burden. While traditional management includes conservative care, pharmacology, and surgery, the evidence surrounding the efficacy of various interventions remains mixed. This review synthesizes current knowledge on modern interventions for sciatica, including advancements in minimally invasive surgery, regenerative medicine, interventional pain management, and digital health. Evidence regarding surgical outcomes suggests that Percutaneous Transforaminal Endoscopic Discectomy (PTED) is superior to conventional Open Microdiscectomy (OM). PTED offers distinct clinical advantages, including significantly reduced intraoperative blood loss and shorter hospital stays, without compromising long-term pain relief. In the field of regenerative medicine, Platelet-Rich Plasma (PRP) injections have demonstrated potential for superior long-term pain reduction and functional improvement compared to traditional corticosteroids and pregabalin. Additionally, prolotherapy presents a viable non-surgical alternative for chronic cases, though more large-scale data is required. Interventional pain management techniques, specifically epidural steroid injections, provide moderate short-term relief. However, their efficacy often diminishes by the twelve-month mark. Spinal Cord Stimulation (SCS) remains an effective tool for improving quality of life, though it has shown limited impact on the restoration of physical function. Finally, the rise of digital health has introduced virtual physiotherapy as a comparable alternative to in-person care, maintaining similar outcomes in pain reduction while increasing healthcare accessibility. In conclusion, while minimally invasive and regenerative therapies offer promising avenues for improved patient recovery, the heterogeneity of current studies highlights the need for standardized protocols. Future research should focus on long-term randomized controlled trials to establish definitive clinical guidelines for these modern interventions.