Clinical Characteristics, Surgical Management and Outcomes of Sciatic Scoliosis Secondary to Lumbar Disc Herniation: A Systematic Review.

Background

Sciatic scoliosis is a nonstructural, compensatory spinal deformity secondary to lumbar disc herniation. In adolescents and young adults, sciatic scoliosis is frequently misdiagnosed as adolescent idiopathic scoliosis due to the low prevalence of lumbar disc herniation in this demographic. Early clinical suspicion is essential, as radiographic features, particularly minimal or absent vertebral rotation on standing radiographs, help distinguish sciatic scoliosis from structural curves such as adolescent idiopathic scoliosis. Key differentiating features include painful scoliosis, a highly positive straight leg raise test, and minimal or absent vertebral rotation on standing radiographs. Delayed diagnosis or inappropriate management may result in residual deformity, highlighting the importance of early surgical decompression. Despite recognition for decades, the literature is fragmented, largely composed of case reports, small series, and retrospective studies, with heterogeneous definitions, radiological assessments, and outcome measures.

Objective

Provide a comprehensive, up-to-date systematic synthesis of the clinical presentation, radiological characteristics, management strategies, and outcomes of lumbar disc herniation-associated sciatic scoliosis.

Methods

Thirteen studies evaluating conventional open discectomy and minimally invasive endoscopic procedures (FEID/PELD) were included. Data on demographics, surgical approach, clinical improvement (VAS, ODI, Macnab), and radiographic correction (Cobb angle, trunk list, sagittal alignment) were extracted and synthesized.

Results

Surgical decompression consistently leads to clinical improvement. Trunk list and coronal deformity were rapidly corrected, with resolution rates ≥ 85% within 6 months across most series. Both open and endoscopic approaches were effective, with minimally invasive techniques offering advantages in tissue preservation and recovery.

Conclusions

Sciatic Scoliosis is a reversible, nonstructural deformity that responds reliably to surgical decompression. Accurate recognition, particularly in adolescents and young adults, and timely intervention targeting the underlying nerve root compression are critical for optimal outcomes. This review consolidates fragmented evidence, providing a comprehensive synthesis of current knowledge.