CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Sciatica (lumbar radiculopathy) - Management
Basis for recommendation
These recommendations are synthesized from national guidelines and are largely based on expert opinion [NICE, 2001; Health Education Board for Scotland and Health and Safety Executive, 2008].
Referral for surgical assessment and opinion on discectomy
- One large, well-conducted, and fully reported randomized controlled trial (RCT) provides strong evidence that early surgery (within about 12 weeks) results in faster relief of pain and disability compared with conservative treatment.
- Economic analysis found that, when societal costs such as loss of earnings were taken into account, the difference in cost was negligible. However, the National Institute for Health and Clinical Excellence does not take loss of earnings into account in its economic analyses because this could bias resource allocation decisions against people who are not earning.
- The study also showed that, at the end of 1 year, outcomes were similar for the two approaches to management, and that dissatisfaction increased during the second year: 5% of people reported an unsatisfactory outcome at the end of the first year, and this increased to 20% the end of the second year.
Referral for physiotherapy
- Referral for physiotherapy is recommended for people who are recovering slowly because there is consistent evidence from three RCTs that physiotherapy may provide statistically significant and clinically important benefits for people with sciatica for at least a year. A Dutch economic analysis of one of the RCTs found that physiotherapy was not cost effective, but it is not clear if the conclusions are generalizable to the UK.
Referral for epidural injection of corticosteroids
- Considering referral for assessment for epidural injection of corticosteroid is recommended because this is performed by some specialists. However, a systematic review of RCTs and two additional RCTs provide mixed evidence, with some positive results and some negative results, on the benefits of epidural or extradural corticosteroid injection compared with placebo [Valat et al, 2003; Ng et al, 2005; Luijsterburg et al, 2007a]. Meta-analysis was not performed, because the studies were too heterogeneous.
© NHS Institute for Innovation and Improvement