Diagnosing sciatica is largely based on taking a patient’s history and making him an undergo physical examination. The patient will be advised to do diagnostic imaging to reveal any infection or malignancies when there are “red flags” or indications that other underlying diseases may be the cause for a person’s sciatica. Patients who have persistent sciatica symptoms even after 6 to 8 weeks of conservative care will be forwarded for diagnostic imaging. If the herniated disc shows extensive nerve root compression, surgery might be considered.
It is crucial for clinical findings and symptoms to match the scan findings before any surgical decisions are made. This is because disc herniations may occur even if a person experiences no clinical symptoms or is not diagnosed with sciatica. Results like these can only be seen using computed tomography or magnetic resonance.
A lot of patients have sciatica symptoms, but no lumbar disc herniations show up on the scans. Some practitioners prefer magnetic resonance imaging due to a higher radiation dose leading to better tissue visualization, but as of the moment, both magnetic resonance and computed tomography are equally accurate in diagnosing lumbar disc herniation. Radiography is not used, because xrays can’t visualize the lumbar disc.
Clinical symptoms of sciatica can be resolved within two weeks through primary care, which may use traction, manipulation, hot packs, or corsets. Results from a random trial showed that about 50% of the patients who underwent sciatica conservative care recovered within three months. This number increased to 70% on the 12-month mark. Conservative sciatica treatments, including injection therapy, are primarily aimed at reducing the pain through analgesics or reducing the pressure on the nerve root. Bed rest is no longer widely considered as a sciatica treatment due to lack of strong evidence and thorough studies to support it. Epidural steroid injections may help patients with acute sciatica, though more studies on its long-term effect are needed. A recent study showed no evidence of good short-term effects with corticosteroid injections. The same study also reported no significant proof of physical therapy (exercises) being better than traction, manipulation, hot packs, corsets, or other conservative sciatica pain management treatment.