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Sciatica

What is sciatica?

If you develop a pain that starts in your lower back or buttock and radiates down your leg, your problem may be sciatica.

Sciatica is an irritation of the sciatic nerve, which is the largest nerve in the human body. Sciatic nerves originate from several nerves in your lower back. These nerves branch outward from the spine and then come together at each buttock to form the sciatic nerve, which then radiates down each leg.

What are the symptoms of sciatica?

The typical first symptom is lower back pain that travels down one leg. Generally, symptoms include:

  • Dull, aching, shooting or "burning" pain that starts in your lower back and/or buttock and radiates down one of your legs. Back pain accompanied by leg pain is the key symptom that suggests you have sciatica rather than another type of back pain.
  • Neuropathies such as numbness or a “pins and needles” tingling sensation.
  • Feelings of muscle weakness or altered reflexes.

Depending on the location of the compressed nerve, your symptoms may worsen when you bend over, lift objects, twist, sit down, cough or sneeze.

What causes sciatica?

Irritation of the sciatic nerve is caused by nerve root entrapment (also known as nerve compression, pinched nerve or entrapment neuropathy). This particular form of entrapment is called lumbar radiculopathy, since the damaged nerves roots are located in the lumbar (lower back) portion of the spine. The nerve compression itself may be caused by:

  • A herniated disc – also known as a ruptured or slipped disc – in which the gel-like center of an intervertebral disc of the spine sticks out through a tear in its outer ring (called the annulus). This slippage puts pressure on the nerve roots located just next to the disc. Herniated discs can be brought on by wear-and-tear over time or by an acute back injury.
  • Spinal stenosis – a narrowing of the canal that houses the spinal nerves.
  • Inflammation of nearby anatomical structures caused by:
    • bone or muscle injuries.
    • diseases such as tumors or infections.
    • pregnancy.

Video: sciatica animation

The animation below illustrates the anatomy of the spine and sciatic nerves and the mechanics of sciatic nerve pain and leg pain.

Thumbnail image of a sciatica animation

How is sciatica treated?

Conservative nonsurgical treatment

If you suspect you have sciatica, tell your doctor about the specific duration and character of your symptoms. The doctor will perform a history and physical examination. After appropriate conservative care, X-rays and MRI scans can confirm whether there is a lumbar nerve root compression.

Conservative treatment is aimed at pain reduction and include:

Your doctor or physical therapist may give you instruction about proper bending and lifting to avoid aggravating your condition. In some cases, epidural steroid injections may also help you return to full activity. Most people with sciatica get relief from their symptoms within several months.

Surgical treatment

For those patients who do not respond conservative care and experience persistent, disabling sciatica, surgery may be warranted. Your doctor will determine whether you are a candidate for surgery based on the duration and severity of symptoms. If your condition is causing cauda equina syndrome (which includes symptoms such as bladder dysfunction, incontinence or severe numbness in the buttocks) may be an indication that you should have immediate surgery.

The surgical treatment for sciatica is spinal decompression surgery. The goal is to remove any disc herniation or stenosis (narrowing of canal) that is pressing on the affected lumbar nerve to ease the leg pain and associated symptoms of numbness and weakness. There are several different decompression surgeries, dependent on which nerve roots are affected. They include:

  • Laminectomy
  • Laminoplasty
  • Laminotomy
  • Microdiscectomy

In general, more than 90% of sciatica surgery patients have successful outcomes.

Additional information about sciatica

Learn more from the articles and other content below, or select Treating Physicians to find the best doctor at HSS for your particular condition and insurance.

Overview articles

Get more information about sciatica and other conditions that cause back pain.

Sciatica diagnosis articles

These articles discuss different methods physicians use to diagnose sciatica and other spine-related conditions.

Sciatica treatment articles

Learn more about treatments for sciatica.

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