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Sciatica  or sciatic neuralgia is a common condition in which one of the spinal nerve roots of the sciatic nerve is compressed resulting in lower back, buttock and leg pain. Sciatic nerve is a large nerve derived from 5 spinal nerve roots (L4, L5, S1, S2 and S3). It runs from the lumbar spine through the buttock down the leg and foot on the posterior side. There is one sciatic nerve on each (right and left) side of the body. Typically only one side of the body is affected.

Fig. 1 : Sciatic nerve anatomy and pain patterns of sciatica. Only one side (right leg) is illustrated for simplicity. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

 

 

 

Symptoms

A typical sciatica pain is described as a sharp shooting pain in the lower back, down the buttock, thigh and leg on one side of the body. There may also be numbness, burning and tingling sensations. The pain can get worse with sitting, moving, sneezing, or coughing.

The patterns of pain depend on which nerve root is compressed, and follow the dermatome distribution (Fig. 1).

Causes

The most common cause of sciatica is herniated spinal disc. The spinal disc is a soft elastic cushion that sits in between the vertebrae of the spine. With age, the discs become rigid and may crack, the gel-like center of the disc may protrude out and become a herniation outside the normal boundaries of the disc. Disc herniation presses on the nerve root as it exits the spine.

Fig. 2 : Anatomy of the lumbar spine, lateral view. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

 

 

 

 

Fig. 3 : Normal disc and herniated disc, superior view. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

Treatment

In majority of the cases the condition resolves by itself after a few weeks of rest and conservative treatment. Pain relief, nonsteroidal anti-inflammatory drugs and muscle relaxants may be prescribed. Stretching exercises and physical therapy may be recommended.

Surgery may be needed if the the pain doesn’t go away after 3 months or more of conservative treatments. The herniated disc may be removed (discectomy) or part of the bone of the vertebrae may be cut to make room for the nerve (laminotomy).