Sciatica is a relatively common condition. The prognosis in most cases is favorable, with spontaneous resolution of leg pain typically within 8 weeks in the majority of patients. A recent randomized trial published in the New England Journal of Medicine followed 283 patients treated for sciatica and/or disc herniations who underwent either conservative care or surgery. Followup MRI imaging performed at 1 year did not correlate with either a favorable or unfavorable outcome. Furthermore, while the conservative care group was noted to have more MRI evidence of a disc herniation and nerve root compression (i.e., “pinched nerve”), this was not associated with a poor outcome.
This study highlights the need for judicious use of serial MRI studies. In addition, it demonstrates that follow up MRI studies should not be used as a measure of prognosis or progress in spine patients. Rather, there should be a clinically relevant need to recommend repeat MRI imaging of the spine.