Sciatica is a term used to describe pain that radiates along the course of the sciatic nerve, the largest nerve in the body, which travels down the leg into the foot. It’s a symptom, not a diagnosis, which usually originates from low back problems including disc herniations, spondylolisthesis, and lumbar stenosis.
Sciatica usually refers to leg pain but may also include other neurologic symptoms including numbness, tingling or weakness. It is often sudden in onset and often described as a sharp “knife like” or a bad “cramping” pain. The pain is typically worse with activities including bending, lifting, and coughing.
The most common cause of sciatic leg pain is from lumbar disc herniations which compress directly on nerve roots that later combine in the pelvis to form the sciatic nerve. Direct pressure and chemicals from the disc herniation inflame and irritate the nerve causing the nerve pain and associated symptoms. Other causes include spondylolisthesis, stenosis, and less commonly neuropathies or pelvic lesions.
The diagnosis is based on characteristic clinical findings obtained following a detailed history and physical examination by an experienced spine specialist. Imaging studies including xray and advanced studies such as CT or MRI might be obtained to confirm the clinical diagnosis.
Most cases of sciatica resolve after a short period of non operative treatment. This may include a 1-2 day period of bed rest, activity modification, NSAIDs (ibuprofen, naproxen), pain medications, epidural steroid injections, and physical therapy.
The majority of patients (80-90%) usually improve within 4-12 weeks without significant limitations or disability.
Patients with severe pain or those with persistent pain despite 3 months of non operative treatment may require surgery. Microdiscectomy is performed to remove symptomatic disc herniations as a minimally invasive, outpatient surgery.other procedures including laminectomy or fusion may be necessary to address other pathologies (stenosis, spondylolisthesis). More recently, minimally invasive spine surgery (MISS) using endoscopic techniques has been used employing endoscopic techniques that minimize soft tissue injury and facilitate faster recovery on an outpatient basis.