Care Plan

Algorithm > 4 weeks - Neurologic Limb Symptoms? - Primarily Leg Pain?

Should Surgery be Performed?

It is recommended that the treating clinician discuss further treatment options with the patient with sciatica after approximately one month of conservative therapy. The clinician should consider referral to a specialist when all of the following conditions are met:

Sciatica is both severe and disabling
Symptoms of sciatica persist without improvement or with progression
There is clinical evidence of nerve root compromise

In patients with severe leg symptoms and confirmed lumbar disc herniation standard discectomy may relieve symptoms faster than continued conservative care. However, there appears to be little difference in long term outcomes at four and ten years between discectomy and conservative care.

The decision for surgery may depend upon the needs of the patient.