Sciatica is pain that starts in the lower back and travels down one of the legs. The sciatic nerve is the longest nerve in the body and is formed when the nerve roots in the lumbosacral spine fuse into one nerve. If the roots become compressed, usually due to a herniated disk, the result is radiating pain known as sciatica.
Herniated disks: An annulus fibrosus defect cause the nucleus pulposus to leak out and irritate the sciatic nerve, causing radiating pain down the leg of the affected side.
Spinal Stenosis: Characterized by narrowing of the spinal canal and/or narrowing of the areas where spinal nerves exit the spinal column. The narrowing can compress the spinal nerves, causes lower back pain that radiates down the leg of the affected side(s).
Spondylolisthesis: One vertebral body slips slightly over another, pinching a nerve root.
Piriformis syndrome: A rare condition in which the piriformis muscle involuntarily contracts, compressing the sciatic nerve, causing pain in the buttock with radiation down the back of the leg.
Risk factors include advancing age, excessive weight from obesity or pregnancy, diabetes, and heavy lifting.
Pain that radiates from the lower back down the back or side of the leg on the affected side. The pain can range from a mild ache to severe, sharp pain. Numbness and tingling may be present as well. In severe cases, weakness may be present in the leg or foot.
The diagnosis starts with a history and physical exam to identify the pattern of the pain. During the physical exam, the physician will look for localized pain in the back, buttock, and leg. She/he will also look for a response to leg motions that elongate the nerve, such as a straight leg raise test and the response to stimuli. Diagnostic imaging may include an MRI, which can identify herniated disks, facet joint inflammation, tumors, and other soft tissue abnormalities. A discogram can also highlight disruptions in intervertebral disks. Selective nerve root injections are an effective way to establish the diagnosis of sciatica. Anesthetic solution is injected adjacent to the nerve roots under radiographic guidance. Pain relief during this procedure aids in confirming the diagnosis of sciatica.
Conservative treatment is the initial step in managing sciatica. Many people will get better with over-the-counter pain relievers, sequential use of cold then hot packs and stretching. It is important to sustain movement as this will help reduce inflammation.
If these simple measures do not result in a significant improvement, stronger prescription medications, such as muscle relaxants can be tried. Physical therapy, acupuncture, and chiropractic care can help.
If symptoms still persist, interventional pain management injections with steroids should be performed by an appropriately trained physician.
Worsening symptoms that involve severe, unremitting pain, weakness of the legs and loss of bowel and bladder function should be addressed by a surgeon.