Sciatica
Sciatica refers to pain that radiates along the path of the sciatic nerve, from the lower back through the hips and buttocks and down the leg. It typically affects one side of the body and is caused by compression of the sciatic nerve roots (L4-S3), most commonly from a lumbar disc herniation or foraminal stenosis.
Symptoms
- Radiating pain from lower back to foot, usually unilateral
- Shooting or electric shock-like pain along posterior leg
- Numbness or tingling in the L4-S1 dermatome
- Weakness in ankle dorsiflexion or plantar flexion
- Pain worsened by sitting, bending, or coughing
- Positive straight leg raise test (Lasègue sign)
Causes
- Lumbar disc herniation (most common, ~90% from L4-L5 or L5-S1)
- Lumbar spinal stenosis with foraminal narrowing
- Degenerative disc disease
- Spondylolisthesis
- Piriformis syndrome (rare)
- Spinal tumors or infections (rare)
Diagnosis
Accurate diagnosis is essential for effective treatment. Clinicians typically use a combination of:
- Clinical examination with dermatomal testing
- Straight leg raise (SLR) test — sensitivity ~91%
- Lumbar MRI (gold standard for disc herniation)
- EMG/Nerve conduction studies for nerve damage assessment
- X-ray for bony pathology screening
- CT myelogram if MRI contraindicated
Treatment Approaches
Related Procedures
🚨 Red Flags
Seek urgent medical evaluation if you experience any of the following:
- ⚠️ Cauda equina syndrome (saddle anesthesia, bladder/bowel dysfunction)
- ⚠️ Progressive motor weakness (foot drop)
- ⚠️ Bilateral symptoms
- ⚠️ Fever, unexplained weight loss, history of cancer
Frequently Asked Questions
Related Conditions
Lumbar Spinal Stenosis
Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal, lateral recesses, or neural foramina in the lumbar spine that results in compression of neural structures. It is the most common reason for spinal surgery in adults over 65 and is typically caused by degenerative changes including disc bulging, facet joint hypertrophy, and ligamentum flavum thickening.
Facet Joint Syndrome
Facet joint syndrome (zygapophyseal joint syndrome) is pain arising from the facet joints of the spine due to degenerative changes, injury, or inflammation. It is a common cause of chronic spinal pain and is diagnosed clinically and confirmed with diagnostic medial branch blocks.
Sacroiliac Joint Dysfunction
Sacroiliac (SI) joint dysfunction refers to pain originating from the sacroiliac joint complex, a common but often underdiagnosed cause of low back and buttock pain. The SI joint transmits forces between the spine and lower extremities and can become painful through inflammatory, degenerative, or traumatic mechanisms.
You May Also Want to Understand
Lumbar Spinal Stenosis
Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal, lateral recesses, or neural foramina in the lumbar spine that results in compression of neural structures. It is the most common reason for spinal surgery in adults over 65 and is typically caused by degenerative changes including disc bulging, facet joint hypertrophy, and ligamentum flavum thickening.
Cervical Radiculopathy
Cervical radiculopathy is pain, numbness, or weakness caused by compression or irritation of a cervical nerve root. It most commonly results from disc herniation or foraminal stenosis and typically affects the C6 or C7 nerve roots.
Facet Joint Syndrome
Facet joint syndrome (zygapophyseal joint syndrome) is pain arising from the facet joints of the spine due to degenerative changes, injury, or inflammation. It is a common cause of chronic spinal pain and is diagnosed clinically and confirmed with diagnostic medial branch blocks.
Sacroiliac Joint Dysfunction
Sacroiliac (SI) joint dysfunction refers to pain originating from the sacroiliac joint complex, a common but often underdiagnosed cause of low back and buttock pain. The SI joint transmits forces between the spine and lower extremities and can become painful through inflammatory, degenerative, or traumatic mechanisms.
Dr. Shahnawaz F Shah
Interventional Spine & Pain Physician
Dr. Shah specializes in the diagnosis and management of sciatica using evidence-based approaches tailored to each patient's needs.
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