In a systematic review and meta-analysis, the use of systemic steroids appeared to be efficient in the management of sciatica caused by lumbar disc herniation (LDH). João Vale et al. sought to assess the impact of systemic corticosteroids in the management of individuals suffering from sciatica.

To identify randomized clinical trials that incorporated subjects experiencing sciatica symptoms due to LDH and were subjected to systemic steroid treatment, databases such as Scopus, EMBASE, and PubMed were explored. The Cochrane RoB2 tool was employed to evaluate the risk of bias. A meta-analysis was performed utilizing a random effects model for calculating the effect size between groups concerning pain and functional outcomes.

The likelihood of adverse events (AEs) was calculated using relative risks (RR). All aggregated outcomes were presented along with their 95% confidence interval (CI). With the aid of Grading of Recommendations, Assessment, Development and Evaluation system (GRADE) framework, the certainty of evidence was assessed. Overall, 10 studies, which included 1,017 volunteers (540 in the treatment arm and 477 in the control arm), met the inclusion criteria.

The use of steroids resulted in a notably greater decline in pain (standardized mean difference [SMD] = -0.42, indicating a weak effect, with very-low certainty), as well as a drop in disability (SMD = -0.30, indicating a weak effect, with very-low certainty). However, it's important to note that corticosteroid administration was linked to a significantly greater risk of experiencing AEs (RR = 2.00, with low certainty).

Administering systemic steroids for managing sciatica caused by LDH appeared justifiable, even though it entails a doubled risk of experiencing mild AEs. Nevertheless, it's worth noting that the impact on pain reduction in the short-term and long-term improvements in functional outcomes is relatively modest.