I need statistics or medical research to show that non-surgical
intervention for right sciatic radiculophy-L4 nerve impingment, L4/5
disc prolapse, due to acute injury(flexon,rotary movement) and
conservative treatment(anti-inflammatory,analgesics,re habilative
exercise program,mobilisation etc) is more benficial than sugical
intervention.

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Request for Question Clarification by lot-ga on 14 Jul 2002 23:01 PDT

hello wal-ga,
I assume that only statistics specific to right sciatic radiculophy-L4
nerve impingement and L4/5 prolapse will do? Rather than more
generalised nerve impingement and disc prolapse statistics.
lot-ga

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Clarification of Question by wal-ga on 15 Jul 2002 00:33 PDT

Hi,any Lumbar disc prolapse with nerve impingment right or left, but
preferably L4/5 disc with associated sciatica.
Thanks Wal

Hello and thanks for your question.

A five-year study, reported in the journal Spine, determined that
where the patient has moderate or severe sciatica, surgical treatment
was associated with greater improvement than nonsurgical treatment at
5 years. However, patients treated surgically were as likely to be
receiving disability compensation, and the relative benefit of surgery
decreased over time.
  Surgical and Nonsurgical Management of Sciatica Secondary to a
Lumbar Disc Herniation Five-Year Outcomes From the Maine Lumbar Spine
Study
Spine 2001;26:1179-1187 
  http://tinyurl.com/o20


Prior to the study cited above, the long-term benefit of surgical
versus nonsurgical treatment for patients with sciatica caused by a
herniated lumbar disc had been assessed in only one randomized
clinical trial:
     Weber H. Lumbar disc herniation: a controlled, prospective study
with ten years of observation. Spine 1983; 8: 131–40.
[Sorry, I can't provide a web citation for this paper, because the
Spine search engine doesn't go back that far; I found it by a Medline
search which requires registration]

In the 1983 study, two hundred eighty patients with herniated lumbar
discs, verified by radiculography, were divided into three groups. One
group consisted of 126 patients with uncertain indication for surgical
treatment, who had their therapy decided by randomization which
permitted comparison between the results of surgical and conservative
treatment. Another group comprising 67 patients had symptoms and signs
that beyond doubt, required surgical therapy. The third group of 87
patients was treated conservatively because there was no indication
for operative intervention. Follow-up examinations in the first group
were performed after one, four, and ten years. The controlled trial
showed a statistically significant better result in the surgically
treated group at the one-year follow-up examination. After four years
the operated patients still showed better results, but the difference
was no longer statistically significant. Only minor changes took place
during the last six years of observation.

Search terms used:
  Lumbar spine prolapse
  Lippincott Spine

I hope this is the information you were looking for.  If you need
anything further, I'd appreciate it if you would request clarification
_before_ you rate this answer.  The job's not done until you're fully
satisfied!

Regards,
richard-ga

Great work richard-ga!!and anyone else that researched.Will use you
again and again.
Wal-ga

There are several articles related to the topic but unfortunately they
do not support your hypothesis.

I noticed in both the question and the answer there is no reference or
request for qualification on what "conservative" treatment is being
carried out.  25 years ago surgical removal of the herniated disc was
considered standard treatment, but in fact unless there were serious
almost emergency symptoms (bowel or bladder dysfunction, serious motor
impairment) physios and surgeons became aware that less severe
herniations tended to resolve within 12-24 months with or without
surgery, since the period of post-surgical recovery must be taken into
consideration.  In this context, conservative treatment involves
physiotherapy, using such tools as exercise, traction, pain control
modalities, education on back care, in addition to the use of
medication prescribed by the physician to address pain and
inflammation.  It is imperative in either case that the patient be an
active participant in his/her recovery, and that the patient take
responsibility for his/her state of health.  Please don't ignore the
value of physical rehabilitation with or without surgical
intervention.