NICE recommends:

• Epidural injections of local anaesthetic and steroid for acute, severe sciatica
• Referral for radiofrequency denervation for moderate to severe low back pain in individuals for whom nonsurgical treatment has not worked and whose pain is believed to arise from structures supplied by the medial branch nerve.
• Spinal injections should not be offered.

Surgical interventions

These are sometimes used for sciatica that is supported by radiological findings; spinal decompression is an option if other treatments have not improved pain or function. NICE states that the decision to refer someone for surgery should not be infl uenced by their BMI, smoking status or psychological distress, but adds that spinal fusion and disc replacement for low back pain should not be offered.