Sciatica is a common pain syndrome caused by compression of nerve roots at the L4/L5 or L5/S1 vertebral levels, most frequently due to intervertebral disc herniation. Symptoms include sharp pain radiating from the lumbar region through the buttock, the posterior and lateral thigh and lower leg, and down to the toes, along with sensory disturbances and muscle weakness. Treatment typically begins with conservative methods, primarily pharmacotherapy. Depending on pain severity, physical therapy is also recommended. In most cases, these approaches are sufficient. Epidural administration of glucocorticoids is one treatment option that has been shown to be effective for pain relief, particularly in the short-term. If there is no improvement, surgical intervention is considered. In Poland, single intramuscular or intravenous injections of dexamethasone are commonly used; however, the lack of scientific consensus prevents this method from being recognised as a standard treatment. The aim of this article is to evaluate the efficacy and rationale for the use of systemic use of glucocorticoids in the conservative treatment of sciatica. Studies on systemic glucocorticoid treatment show improvement in some patients, but the results remain inconclusive. Limitations include low statistical power due to small patient groups, inconsistent therapy protocols, and short follow-up periods. Systematic reviews and guidelines from international medical organisations suggest alternative therapeutic approaches, and systemic glucocorticoid use is generally not recommended for the treatment of sciatica. Therefore, continued research into this treatment method is necessary. Until more reliable data become available, it is advisable to follow current guidelines and the conclusions of meta-analyses.
Stępień et al. (Fri,) studied this question.