[Efficacy of tumor necrosis factor-alpha blockade for severe sciatica?].

The domain of sciatica is at the edge of a mini revolution. For ten years evidence have been accumulating in favour of a local inflammation rather than a pathology resulling only from a nerve compression. This hypothesis has first been strengthened by the discovery of inflammatory mediators in human herniated discs and then by animal models. These models have demonstrated the impossibility for nerve root compression to produce sciatica in the absence of inflammation and the importance of proinflammatory cytokines in this pathology. TNF-alpha have been proved to be the most important inflammatory cytokine and TNF-alpha modulators has been most effective in the treatment of these models. Two pilot studies realized on humans seem to confirm these experimental data. A multicenter randomised, double-blind, placebo controlled study is being planed in Switzerland.