What is Sciatica?

Sciatica is pain that travels along the path of the sciatic nerve, often from the lower back into the buttock, hip, thigh, calf, or foot. The term sciatica describes a symptom pattern rather than one single diagnosis.

Sciatica is commonly related to lumbar radiculopathy, which means irritation or compression of a nerve root in the lower spine. Patients may describe sciatica as sharp, burning, shooting, electric-like, or radiating leg pain. It may occur with numbness, tingling, weakness, or difficulty walking.

De Novo Brain & Spine evaluates adult patients with sciatica when symptoms suggest lumbar nerve compression, herniated disc, spinal stenosis, spondylolisthesis, spinal instability, or another spine-related condition that may require neurosurgical review.

Common Signs and Symptoms

Sciatica symptoms depend on which lumbar or sacral nerve root is affected and how severe the nerve irritation or compression is.

Common signs and symptoms may include:

• Lower back pain with pain traveling into the buttock, hip, thigh, calf, or foot
• Sharp, burning, shooting, or electric-like leg pain
• Pain that travels below the knee
• Numbness or tingling in the leg or foot
• Pins-and-needles sensation in the leg or foot
• Weakness in the leg, ankle, or foot
• Foot drop, meaning difficulty lifting the front of the foot
• Pain that worsens with sitting, bending, coughing, sneezing, or certain movements
• Pain that worsens with standing or walking in some spinal stenosis cases
• Symptoms that improve with position changes in some patients
• Difficulty walking normally because of pain, weakness, or numbness

Seek urgent medical evaluation for sciatica with progressive weakness, foot drop, numbness in the groin or saddle area, new bowel or bladder problems, fever, unexplained weight loss, history of cancer, severe pain after trauma, or rapidly worsening neurological symptoms. Seek emergency medical care or call 911 for symptoms concerning for cauda equina syndrome, including loss of bowel or bladder control, severe leg weakness, or saddle anesthesia.

What Causes This Condition?

Sciatica occurs when the sciatic nerve pathway or the spinal nerve roots that form the sciatic nerve become irritated, inflamed, or compressed. In many patients, the problem begins in the lumbar spine.

Possible causes and related conditions may include:

• Lumbar herniated disc, when disc material presses on or irritates a nerve root
• Lumbar radiculopathy, or irritation of a nerve root in the lower back
• Lumbar spinal stenosis, which is narrowing around the spinal canal or nerve roots
• Foraminal stenosis, which is narrowing where a nerve exits the spine
• Degenerative disc disease, involving wear or breakdown of spinal discs
• Spondylolisthesis, when one vertebra slips forward relative to another
• Facet joint disease or arthritis-related spine changes
• Bone spurs, also called osteophytes
• Spinal instability
• Traumatic spine injury in selected cases
• Vertebral compression fracture or other spinal fracture in selected cases
• Spinal tumor, infection, or inflammatory disease in selected cases
• Less commonly, irritation of the sciatic nerve outside the spine

These causes and risk factors do not mean every patient with sciatica has a serious spine condition. Treatment planning depends on symptoms, neurological examination, imaging findings when needed, response to prior care, and the patient’s overall health.

How It Is Diagnosed?

Sciatica is diagnosed through medical history, physical examination, neurological examination, and imaging or additional testing when appropriate. The goal is to identify whether symptoms are caused by lumbar nerve root compression, peripheral nerve irritation, or another condition.

Common diagnostic steps may include:

• Medical history and symptom review to understand pain location, leg pain pattern, numbness, tingling, weakness, triggers, injury history, prior treatment, and red-flag symptoms
• Physical examination to evaluate posture, range of motion, tenderness, muscle spasm, walking pattern, and painful movement
• Neurological examination to assess strength, sensation, reflexes, coordination, gait, balance, and signs of nerve root involvement
• Straight leg raise testing or other nerve tension testing when lumbar radiculopathy or disc herniation is suspected
• X-rays of the lumbar spine to evaluate alignment, arthritis, disc space narrowing, spondylolisthesis, fracture, or degenerative change
• Flexion-extension X-rays in selected cases to assess abnormal motion or spinal instability
• MRI of the lumbar spine when nerve compression, herniated disc, spinal stenosis, tumor, infection, fracture, or significant neurological symptoms are suspected
• CT scan of the lumbar spine when bone detail, fracture, or surgical planning requires further evaluation
• CT myelogram in selected cases when MRI is not possible or when additional detail around the spinal canal and nerve roots is needed
• Electromyography and nerve conduction studies, also called EMG/NCS, when symptoms may involve lumbar radiculopathy, peroneal neuropathy, peripheral neuropathy, or another nerve disorder
• Blood tests in selected cases when infection, inflammatory disease, cancer-related concern, or another medical condition is suspected

The goal of diagnosis is to identify the source of nerve irritation, determine whether nerve compression is present, and decide whether conservative care, injections, or surgical evaluation may be appropriate.

Treatment Options

Sciatica treatment depends on the cause, severity, duration, neurological examination, imaging findings, prior treatment, activity limitations, and overall health. Many patients begin with non-surgical care when there is no progressive weakness, cauda equina syndrome, fracture, infection, tumor, or other urgent concern.

Treatment options may include:

• Activity modification to reduce positions, movements, or lifting that worsen symptoms
• Physical therapy to improve lumbar mobility, core strength, flexibility, posture, and walking mechanics
• Home exercise and stretching when recommended by a clinician or therapist
• Heat, ice, or other comfort measures for short-term symptom relief
• Anti-inflammatory medication, acetaminophen, muscle relaxants, or nerve pain medication when medically appropriate
• Treatment of posture, ergonomic, or activity-related contributors
• Lumbar epidural steroid injection in selected cases involving lumbar radiculopathy or nerve inflammation
• Selective nerve root block in selected cases when diagnostic or therapeutic nerve-targeted injection is appropriate
• Microdiscectomy in selected cases involving lumbar disc herniation with persistent or progressive nerve compression symptoms
• Lumbar laminectomy or decompression in selected cases involving spinal stenosis or nerve root compression
• Lumbar fusion, such as transforaminal lumbar interbody fusion, lateral interbody fusion, or anterior lumbar interbody fusion, in selected cases involving instability, deformity, spondylolisthesis, or certain recurrent spine conditions
• Treatment of fracture, tumor, infection, or other structural cause when one is identified
• Rehabilitation and follow-up care to support strength, walking, mobility, nerve recovery, and symptom monitoring

Surgery is not appropriate for every patient with sciatica. Neurosurgical treatment may be considered when sciatica is caused by structural nerve compression, progressive weakness, foot drop, spinal stenosis, herniated disc, instability, or symptoms that do not improve with appropriate non-surgical care.