Sciatica

Sciatica describes pain that travels along the path of the sciatic nerve, from the lower back or buttock down the back of the leg. It is a symptom rather than a diagnosis: it happens when a nerve root in the lower spine is irritated or compressed, most often by a herniated disc or spinal stenosis.

• Pain that radiates from the buttock down the back or side of the leg, sometimes into the foot
• Burning, sharp, or electric-like pain
• Numbness, tingling, or weakness in the leg or foot
• Pain that is often worse with sitting, coughing, or sneezing
• Symptoms that usually affect one leg

Diagnosis is based on symptoms and an examination. Imaging is usually not needed at first; an MRI may be ordered if symptoms persist, if there is weakness, or if an injection or surgery is being considered.

Many episodes of sciatica improve over weeks with non-operative care: staying as active as comfort allows, heat or ice, medications, and physical therapy. An image-guided epidural steroid injection may help when pain persists.

When sciatica remains severe despite non-operative care, or when weakness is getting worse, surgery to relieve pressure on the nerve may be discussed. The operation depends on the cause — for example, a microdiscectomy for a herniated disc or a decompression for stenosis.