Sciatica is caused by nerve root entrapment, lumbar radiculopathy (irritation resulting from damage to discs of the lower spine), or irritation to the nerves that exit the lower back and travel down to the legs. The typical first symptom is pain that starts in your lower back or buttock and radiates down your leg. Patients with sciatica may also experience numbness, a “pins and needles” sensation, muscle weakness, and reflex changes. Symptoms may be worsened by bending, lifting, twisting, sitting, coughing, or sneezing. These symptoms can be brought on by wear and tear over time or by an injury causing a rupture or herniation of a disc, when the inner contents (a gel-like nucleus) protrudes through the torn outer ring (annulus) affecting the adjacent nerve roots.
Conservative treatment is aimed at pain reduction. Initial treatment starts with cold packs or heat, NSAIDs (non-steroidal anti-inflammatory medications), muscle relaxants, pain medications, and alternative therapies such as acupuncture. Education about proper mechanics (bending and lifting), physical therapy, and epidural steroid injections may also help patients return to full activity. The majority of patients with sciatica have a favorable outcome with natural resolution of symptoms in several months.
Some patients who do not respond to non-surgical care and who experience persistent, disabling sciatica may benefit from surgery.