Clinical Review

Diagnosis and treatment of sciatica

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39223.428495.BE (Published 21 June 2007) Cite this as: BMJ 2007;334:1313
  1. B W Koes, professor1,
  2. M W van Tulder, professor of health technology assessment2,
  3. W C Peul, neurosurgeon3
  1. 1Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, Netherlands
  2. 2EMGO Institute, VU University Medical Center, Amsterdam, Netherlands
  3. 3Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
  1. Correspondence to: B W Koes b.koes{at}erasmusmc.nl

    Sciatica affects many people. The most important symptoms are radiating leg pain and related disabilities. Patients are commonly treated in primary care but a small proportion is referred to secondary care and may eventually have surgery. Many synonyms for sciatica appear in the literature, such as lumbosacral radicular syndrome, ischias, nerve root pain, and nerve root entrapment.

    Summary points

    • Most patients with acute sciatica have a favourable prognosis but about 20%-30% have persisting problems after one or two years

    • The diagnosis is based on history taking and physical examination

    • Imaging is indicated only in patients with “red flag” conditions or in whom disc surgery is considered

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

    • Consensus is that initial treatment is conservative for about 6-8 weeks

    • Disc surgery may provide quicker relief of leg pain than conservative care but no clear differences have been found after one or two years

    In about 90% of cases sciatica is caused by a herniated disc with nerve root compression, but lumbar stenoses and (less often) tumours are possible causes. The diagnosis of sciatica and its management varies considerably within and between countries—for example, the surgery rates for lumbar discectomy vary widely between countries.w1 A recent publication confirmed this large variation in disc surgery, even within countries.1 This may in part be caused by a paucity of evidence on the value of diagnostic and therapeutic interventions and a lack of clear clinical guidelines or reflect differences in healthcare and insurance systems. This review presents the current state of science for the diagnosis and treatment of sciatica.

    Sources and selection criteria

    We identified systematic reviews in the Cochrane Library evaluating the effectiveness of conservative and surgical interventions for sciatica. Medline searches up to December 2006 were carried out to find other relevant systematic reviews on the diagnosis …

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