Sciatica

Sciatica is pain that travels from the lower back or buttock down the back of one leg, often reaching the calf or foot. It happens when one of the nerve roots that join to form the sciatic nerve is pressed or irritated in the lower spine. Sciatica is a symptom rather than a disease in itself, and most people improve without surgery.

Symptoms

• Sharp, burning or shooting pain from the buttock down one leg, often below the knee
• Pain that worsens on sitting for long, bending forward, coughing or sneezing
• Tingling, pins and needles or numbness in the leg or foot
• Weakness of the leg or foot, such as difficulty standing on the heels or toes
• Lower back pain, although the leg pain is usually worse than the back pain

Causes

• Slipped (herniated) disc in the lower back, the most common cause
• Lumbar canal stenosis, a narrowing of the spinal canal that develops with age
• Spondylolisthesis, where one vertebra slips forward over the one below
• Bony spurs and thickened ligaments due to wear and tear (spondylosis)
• Less commonly, infection, tumour or injury of the spine

Diagnosis

Diagnosis begins with a detailed history and a careful neurological examination of strength, sensation and reflexes in the legs. Simple bedside tests, such as raising the straightened leg, help show nerve irritation. An MRI of the lumbar spine is the most useful test to see the discs and nerve roots. X-rays may be advised to check alignment and stability, and nerve conduction studies are occasionally needed when the picture is unclear. Scan findings are always matched with the examination, because disc changes are common even in people without pain.

Treatment

Most episodes of sciatica settle within a few weeks to a few months with non-surgical care. This includes a short period of relative rest followed by staying gently active, pain-relieving and nerve-calming medicines prescribed by your doctor, and a guided physiotherapy programme to strengthen the back and core muscles. Good posture, safe lifting and weight control help prevent the pain from returning. For pain that persists, an image-guided nerve root injection may be considered.

Surgery is advised when pain does not improve despite adequate conservative treatment, when there is significant or worsening weakness, or in emergencies such as cauda equina syndrome. The common operation is a microdiscectomy, in which the part of the disc pressing on the nerve is removed through a small incision using an operating microscope. In selected patients, an endoscopic discectomy through an even smaller opening may be suitable. Where narrowing of the canal is the cause, the nerves are freed by decompression. The choice of procedure depends on your examination and MRI findings.

When to Seek Urgent Care

Go to the nearest emergency immediately if you have any of the following:

• Loss of bladder or bowel control, or difficulty passing urine
• Numbness around the private parts, buttocks or inner thighs
• Sudden or rapidly worsening weakness in one or both legs, or foot drop
• Sciatica in both legs at the same time
• Back and leg pain with fever, unexplained weight loss or a history of cancer

If your leg pain is not settling or is affecting your daily life, you are welcome to consult Dr. Prashant Sharma at Keshav Super Speciality Hospital, Meerut, for a careful evaluation.

Related Conditions

• Back Pain (Backache)
• Neck Pain
• Cervical Pain
• Cervical Spondylosis
• All Spinal Treatment ›