🦵 Sciatica Treatment Decision Pathway Simulator

Symptom Onset and First-Line Conservative Care

Sciatica pathway starts with conservative first-line therapy, not surgery.

• PT + NSAID: First-line therapy (started at diagnosis)
• Day 0: Red flags screened (cauda equina ruled out)
• 2–4 wks: Typical onset relief (for most patients)
• <5%: Early surgery need (of new cases)

Why conservative care comes first

Most sciatica resolves without surgery within weeks.

The Six-Week Physical Therapy and NSAID Window

A structured six-week trial anchors the decision timeline.

• 6 weeks: Trial length (standard guideline window)
• 2×/week: PT sessions (typical frequency)
• Ongoing: NSAID course (as tolerated)
• Weekly: Checkpoint interval (progress reviewed)

Weekly checkpoint logic

Each week logs pain, function, and deficit status.

Treatment Response Assessment at Week Six

Response is scored to decide continue, extend, or escalate.

• >50%: Good response (pain/function improvement)
• 20–50%: Partial response (may extend trial)
• <20%: Poor response (triggers escalation review)
• VAS, ODI: Assessment tools (standard scales)

Scoring the response

Response score drives the next branch decision.

Neurological Deficit Progression Check

Worsening motor or sensory deficit can override the timeline.

• Grade ≤3: Motor deficit alert (muscle strength)
• Urgent: Progressive deficit (fast-track surgery)
• Emergency: Cauda equina signs (immediate surgery)
• Monitor: Stable mild deficit (continue conservative)

Deficit overrides schedule

Severe or worsening deficit bypasses the six-week wait.

Surgical Microdiscectomy Branch Decision

Failure of conservative care or deficit progression routes to surgery.

• ~90%: Microdiscectomy success (leg pain relief)
• Fail @ wk6: Branch trigger (or deficit progression)
• 2–6 wks: Recovery time (post-op typical)
• If passing: Conservative continuation (no surgery needed)

The branch decision

Pathway ends in continued care or referral to surgery.