***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract This single-blind r and omised clinical trial compared osteopathic manipulative treatment with chemonucleolysis ( used as a control of known efficacy ) for symptomatic lumbar disc herniation . Forty patients with sciatica due to this diagnosis ( confirmed by imaging ) were treated either by chemonucleolysis or manipulation . Outcomes ( leg pain , back pain and self-reported disability ) were measured at 2 weeks , 6 weeks and 12 months . The mean values for all outcomes improved in both groups . By 12 months , there was no statistically significant difference in outcome between the treatments , but manipulation produced a statistically significant greater improvement for back pain and disability in the first few weeks . A similar number from both groups required additional orthopaedic intervention ; there were no serious complications . Crude cost analysis suggested an overall financial advantage from manipulation . Because osteopathic manipulation produced a 12-month outcome that was equivalent to chemonucleolysis , it can be considered as an option for the treatment of  symptomatic lumbar disc herniation  , at least in the absence of clear indications for surgery . Further study into the value of manipulation at a more acute stage is warranted The management of sciatica due to lumbar nerve root compromise remains controversial , probably because few well-controlled studies of conservative management have been performed . This preliminary study assesses the efficacy of epidural injections of 80 mg triamcinolone acetonide plus 0.5 % procaine hydrochloride in saline , administered via the caudal route , in a double-blind , placebo controlled trial with 1 year follow-up . Twenty-three patients were entered into the study : 12 received treatment and 11 placebo .  The active group showed significant pain relief ( P=0.02 ) and a significant increase in mobility ( P=0.01 ) at 4 weeks , which result ed in improved quality of life ( P=0.02 ) . At 1 year , subjective and objective measures improved in both groups . The improvement was greater in the actively treated group , but only the objective assessment ( straight leg raise ) was statistically significant BACKGROUND Although epidural corticosteroid injections are commonly used for sciatica , their efficacy has not been established . METHODS In a r and omized , double-blind trial , we administered up to three epidural injections of methylprednisolone acetate ( 80 mg in 8 ml of isotonic saline ) or isotonic saline ( 1 ml ) to 158 patients with sciatica due to a herniated nucleus pulposus . All patients had Oswestry disability scores higher than 20 ( on a scale of 1 to 100 , with scores of 20 or less indicating minimal disability , and higher scores greater disability ) . RESULTS At three weeks , the Oswestry score had improved by a mean of -8.0 in the methylprednisolone group and -5.5 in the placebo group ( 95 percent confidence interval for the difference , -7.1 to 2.2 ) . Differences in improvements between the groups were not significant , except for improvements in the finger-to-floor distance ( P=0.006 ) and sensory deficits ( P=0.03 ) , which were greater in the methylprednisolone group . After six weeks , the only significant difference was the improvement in leg pain , which was greater in the methylprednisolone group ( P=0.03 ) . After three months , there were no significant differences between the groups . The Oswestry score had improved by a mean of -17.3 in the methylprednisolone group and -15.4 in the placebo group ( 95 percent confidence interval for the difference , -9.3 to 5.4 ) . At 12 months , the cumulative probability of back surgery was 25.8 percent in the methylprednisolone group and 24.8 percent in the placebo group ( P=0.90 ) . CONCLUSIONS Although epidural injections of methylprednisolone may afford short-term improvement in leg pain and sensory deficits in patients with sciatica due to a herniated nucleus pulposus , this treatment offers no significant functional benefit , nor does it reduce the need for surgery This study reports on 105 patients with acute low-back pain given tizanidine  ( 4 mg three times daily ) plus ibuprofen ( 400 mg three times daily ) or placebo plus ibuprofen ( 400 mg three times daily ) . Patients assessed their pain using visual analogue scales in a daily diary and the doctor assessed their condition at baseline and on days 3 and 7 . Both groups were treated effectively , but earlier improvement occurred in patients given tizanidine/ibuprofen , particularly regarding pain at night and at rest . Doctors assessed the helpfulness of treatment : tizanidine/ibuprofen was significantly better than placebo/ibuprofen at day 3 ( P = 0.05 ) . Significant differences between treatments in favour of tizanidine/ibuprofen occurred in patients with moderate and severe pain at night ( P<0.05 ) , at rest ( P<0.05 ) and those with moderate or severe sciatica ( P<0.05 ) . Significantly more patients given placebo/ibuprofen had gastro-intestinal side-effects compared with tizanidine/ibuprofen ( P = 0.002 ) . This supports previous work in animals showing that tizanidine mediates gastric mucosal protection against anti-inflammatory drugs . More patients given tizanidine/ibuprofen suffered drowsiness and other central nervous system effects ( P = 0.025 ) . In patients with severe acute low-back pain , however , some sedation and bed rest is advantageous . This study shows that tizanidine/ibuprofen is more effective in the treatment of moderate or severe acute low-back pain than placebo and ibuprofen alone The effect of extradural corticosteroid injection in patients with nerve root compression syndromes associated with degenerative disease of the lumbar intervertebral discs was assessed in a double-blind controlled trial on 100 consecutive in patients assigned by r and om allocation to treatment and control groups . Assessment during admission and at three months revealed statistically highly significant differences in respect of relief of pain and resumption of normal occupation in favour of the group treated by extradural injection . This treatment seems to be a valuable adjunct to the management of lumbar nerve root compression syndromes associated with degenerative disc disease The value of epidural injections of corticosteroid as an outpatient treatment of sciatica has been hitherto uncertain . An epidural injection of 80 mg methylprednisolone in 10 ml physiological saline was compared with an interspinous injection of 2 ml physiological saline in a double blind fashion amongst 39 out patients . Significant differences of pain relief were seen between the two groups within 2 weeks . This benefit disappeared for six ( 35 % ) patients within 6 months of treatment although 11 ( 65 % ) successfully treated subjects had sustained improvement up to this time . Outpatient epidural injections of corticosteroid are thus a useful short-term means of relieving pain in sciatica but probably have little effect on the long-term natural history of symptoms . Factors associated with a failure to respond to epidural steroid injections are discussed Four treatment regimens for patients with specified combinations of low back pain and sciatica were evaluated . The largest group studied had low back pain with limited straight-leg raising ( SLR ) and in them the beneficial effect of manipulation in hastening pain relief was highly significant . In similar patients without limitation of SLR , the effect was of borderline significance . In all the other groups , treated patients also recovered more quickly than their controls . Traction , for patients with low back pain and sciatica , and epidural injections when a root palsy was present also produced some significant pain relief . The effect of sclerosants for back pain was less clear OBJECT The authors conducted a study to compare the efficacies of three nonsurgical treatment strategies in patients with sciatica . Their hypothesis was that bed rest , physiotherapy , and continuation of activities of daily living ( ADLs ) ( control treatment ) are each of equivalent efficacy . METHODS This r and omized controlled trial was design ed for comparison of bed rest , physiotherapy , and continuation of ADLs . The setting was an outpatient clinic . General practitioners were asked to refer patients for treatment as soon as possible . The authors enrolled 250 patients ( < 60 years of age ) with sciatica of less than 1-month 's duration and who had not yet been treated with bed rest or physiotherapy .  Primary outcome measures were radicular pain ( based on a visual analog pain scale [ VAPS ] ) and hampered ADLs ( Quebec Disability Scale [ QDS ] ) . Secondary outcome measures were the rates of treatment-related failure and surgical treatment . Measures were assessed at baseline and during follow up at 1 , 2 , and 6 months . Mean differences in VAPS and QDS scores between bed rest and control treatment were 2.5 ( 95 % confidence interval [ CI ] -6.4 to 11.4 ) and -4.8 ( 95 % CI -10.6 to 0.9 ) at 1 month and 0.9 ( 95 % CI -8.7 to 10.4 ) and -2.7 ( 95 % CI -9.9 to 4.4 ) at 2 months , respectively . The respective differences between physiotherapy and control treatment were 0.8 ( 95 % CI -8.2 to 9.8 ) and -0.5 ( 95 % CI -6.3 to 5.3 ) at 1 month and -0.3 ( 95 % CI -9.4 to 10 ) and 0.0 ( 95 % CI -7.2 to 7.3 ) at 2 months . The respective odds ratios for treatment failure and surgical treatment of bed rest compared with control treatment were 1.6 ( 95 % CI 0.8 - 3.5 ) and 1.5 ( 95 % CI 0.7 - 3.6 ) at 6 months . When physiotherapy was compared with control treatment , these ratios were 1.5 ( 95 % CI 0.7 - 3.2 ) and 1.2 ( 95 % CI 0.5 - 2.9 ) at 6 months , respectively . CONCLUSIONS Bed rest and physiotherapy are not more effective in acute sciatica than continuation of ADLs Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists A prospect i ve , r and omised , double-blind study was carried out to compare the respective efficacies of transforaminal and interspinous epidural corticosteroid injections in discal radiculalgia . Thirty-one patients ( 18 females , 13 males ) with discal radicular pain of less than 3 months ’ duration were consecutively r and omised to receive either radio-guided transforaminal or blindly performed interspinous epidural corticosteroid injections . Post-treatment outcome was evaluated clinical ly at 6 and 30 days , and then at 6 months , but only by mailed question naire . At day 6 , the between-group difference was significantly in favour of the transforaminal group with respect to Schober ’s index , finger-to-floor distance , daily activities , and work and leisure activities on the Dallas pain scale . At day 30 , pain relief was significantly better in the transforaminal group . At month 6 , answers to the mailed question naire still showed significantly better results for transforaminal injection concerning pain , daily activities , work and leisure activities and anxiety and depression , with a decline in the Rol and –Morris score . In recent discal radiculalgia , the efficacy of radio-guided transforaminal epidural corticosteroid injections was higher than that obtained with blindly-performed interspinous injections Study Design . A r and omized , double-blind trial was conducted . Objectives . To test the efficacy of periradicular corticosteroid injection for sciatica . Summary of Background Data . The efficacy of epidural corticosteroids for sciatica is controversial . Periradicular infiltration is a targeted technique , but there are no r and omized controlled trials of its efficacy . Methods . In this study 160 consecutive , eligible patients with sciatica who had unilateral symptoms of 1 to 6 months duration , and who never underwent surgery were r and omized for double-blind injection with methylprednisolone bupivacaine combination or saline .  Objective and self-reported outcome parameters and costs were recorded at baseline , at 2 and 4 weeks , at 3 and 6 months , and at 1 year . Results . Recovery was better in the steroid group at 2 weeks for leg pain ( P = 0.02 ) , straight leg raising ( P = 0.03 ) , lumbar flexion ( P = 0.05 ) , and patient satisfaction ( P = 0.03 ) . Back pain was significantly lower in the saline group at 3 and 6 months ( P = 0.03 and 0.002 , respectively ) , and leg pain at 6 months ( 13 
    Output:
    
At present there is no evidence that one type of treatment is clearly superior to others , including no treatment , for patients with a lumbosacral radicular syndrome