This systematic review and meta-analysis included 24 randomized controlled trials with 1711 participants diagnosed with sciatica due to lumbar disc herniation. It compared surgical treatment, primarily discectomy, to non-surgical treatments and epidural steroid injections. The primary outcomes assessed were leg pain and disability, while secondary outcomes included adverse events, back pain, quality of life, and treatment satisfaction. The pooled results indicated that discectomy provided moderate reductions in leg pain in the short term, with diminishing benefits over time. Effects on disability were smaller, showing only minor improvements. The long-term outcomes revealed no significant differences between surgical and non-surgical treatments. These findings suggest that discectomy offers early pain relief but does not provide sustained long-term advantages over non-surgical options.