What role do imaging studies play in the management of sciatica in primary care settings?

Role of Imaging Studies in the Management of Sciatica in Primary Care:

Imaging studies are not routinely recommended in primary care for people presenting with sciatica unless there are red flag symptoms or signs suggesting a serious underlying cause such as cauda equina syndrome, spinal cord compression, tumour, or infection. In such cases, urgent referral and imaging (usually MRI) within 2 weeks is advised to guide specialist management.

For patients without red flags, imaging is generally deferred because it is unlikely to change initial management, which focuses on clinical assessment, risk stratification (e.g., using the STarT Back tool), and conservative treatment including self-management advice and analgesia.

Imaging may be considered later in specialist settings if the results are likely to influence treatment decisions, particularly if symptoms persist or worsen despite initial management.