Diagnosis and treatment of sciatica

doi:10.1136/bmj.39223.428495.BE

BMJ 2007;334:1313-1317 (23 June), doi:10.1136/bmj.39223.428495.BE

Clinical Review

Diagnosis and treatment of sciatica

B W Koes, professor¹, M W van Tulder, professor of health technology assessment², W C Peul, neurosurgeon³

¹ Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, Netherlands , ² EMGO Institute, VU University Medical Center, Amsterdam, Netherlands , ³ Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands

Correspondence to: B W Koes b.koes@erasmusmc.nl

The first 150 words of the full text of this article appear below.

Sciatica affects many people. The most important symptoms areradiating leg pain and related disabilities. Patients are commonlytreated in primary care but a small proportion is referred tosecondary care and may eventually have surgery. Many synonymsfor sciatica appear in the literature, such as lumbosacral radicularsyndrome, ischias, nerve root pain, and nerve root entrapment.

Summary points

Most patients with acute sciatica have a favourableprognosis but about 20%-30% have persisting problems after oneor two years

The diagnosis is based on history taking and physicalexamination

Imaging is indicated only in patients with "redflag" conditions or in whom disc surgery is considered

Passive(bed rest) treatments have been replaced with more active treatments

Consensusis that initial treatment is conservative for about 6-8 weeks

Discsurgery may provide quicker relief of leg pain than conservativecare but no clear differences have been found after one or twoyears

. . . [Full text of this article]

Sources and selection criteria

Who gets sciatica?

Box 1: Risk factors for acute sciatica³^w2
Personal factors
Occupational factors

How is sciatica diagnosed?

Box 2: Indicators for sciatica^w5

What is the value of imaging?

What is the prognosis?

What is the efficacy of conservative treatments for sciatica?

Box 3: Levels of evidence for conservative treatments for sciatica

What is the role of surgery in sciatica?

Randomised controlled trials not yet included in systematic reviews

What are the recommendations in clinical guidelines?

Box 4: Clinical guideline for diagnosis and treatment of sciaticafrom Dutch College of General Practice^w4
Diagnosis
Treatment

Promising developments

Future research

Additional educational resources
A patient's perspective (A)
A patient's perspective (B)

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Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation: cost utility analysis alongside a randomised controlled trial: Wilbert B van den Hout, Wilco C Peul, Bart W Koes, Ronald Brand, Job Kievit, Ralph T W M Thomeer, and for the Leiden-The Hague Spine Intervention Prognostic Study Group
BMJ 2008 336: 1351-1354. [Abstract] [Full Text] [PDF]

Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial: Wilco C Peul, Wilbert B van den Hout, Ronald Brand, Ralph T W M Thomeer, Bart W Koes, and for the Leiden-The Hague Spine Intervention Prognostic Study Group
BMJ 2008 336: 1355-1358. [Abstract] [Full Text] [PDF]

An archaic term: Jeremy C T Fairbank
BMJ 2007 335: 112. [Extract] [Full Text] [PDF]

Changing what we do: Douglas Kamerow
BMJ 2007 334: 0. [Extract] [Full Text]

This article has been cited by other articles:

Hout, W. B v. d., Peul, W. C, Koes, B. W, Brand, R., Kievit, J., Thomeer, R. T W M, for the Leiden-The Hague Spine Intervention Progno, (2008). Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation: cost utility analysis alongside a randomised controlled trial. BMJ 336: 1351-1354 [Abstract] [Full text]
Peul, W. C, Hout, W. B v. d., Brand, R., Thomeer, R. T W M, Koes, B. W, for the Leiden-The Hague Spine Intervention Progno, (2008). Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial. BMJ 336: 1355-1358 [Abstract] [Full text]
Fairbank, J. C T (2007). An archaic term. BMJ 335: 112-112 [Full text]

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