Sciatica and its treatment

BMJ, published 27 May 2008.

Editorials.
By: Jeremy Fairbank, professor of spinal surgery, Nuffield Orthopaedic Centre, Oxford OX3 7L

* Prolapsed intervertebral disc is common.
* Disc prolapse is genetically driven—twin studies indicate that at least 60% of the variance can be explained on genetic grounds and not by the commonly assumed environmental factors (work, trauma, exposure to excessive driving, smoking, and so on).

Current guidelines indicate that radicular pain should improve within six to eight weeks with conservative management.

* Surgery should be performed before eight weeks only in patients with progressive neurological deficit, which can be detected by magnetic resonance imaging.

If symptoms persist, evidence supports surgery after eight weeks.