Memphis Orthopaedic Group

What is it?

Sciatica is a term used to describe pain which radiates from the lower back into the buttock, down the back of the thigh into the calf. The pain travels along the distribution  of the sciatic nerve which is the largest nerve in the body. The majority of cases of sciatica resolve in a few weeks or months with conservative treatment, but occasionally symptoms can be severe and may require further diagnostic evaluation and treatment. It occurs most commonly in patients 30-50 years old.

What causes sciatica?

It is typically caused by a disorder in the lower back or lumbar spine which causes compression of the nerve roots in the spine which join together to form the sciatic nerve. (L4, L5, S1, S2, S3 spinal nerve roots) The most common causes of sciatica include lumbar disc herniation, spinal stenosis, spondylolisthesis and degenerative disc disease. Rare causes of sciatica include infection, tumors or trauma. Sciatic pain can be caused by an injury, but usually occurs secondary to aging changes in the lumbar spine.

What are the symptoms?

Sciatica is a group of symptoms and not a diagnosis or medical disorder.
It may be accompanied by numbness and tingling and sometimes weakness in the lower extremity. Sciatic symptoms usually affect one extremity. Occasionally it can involve both extremities. Symptoms can be severe and disabling or mild and intermittent. Symptoms are often worsened by sitting, standing, walking, coughing or sneezing.

If weakness or loss of sensation develops, the patient should be evaluated by a spine specialist. Permanent neurologic damage rarely occurs. In rare cases, progressive weakness of the lower extremities, progressive sensory loss, or bowel and/or bladder incontinence can occur. This is a sign of cauda equina syndrome which is a medical emergency requiring urgent surgical intervention.

How is it diagnosed and treated?

Diagnosing the cause of sciatica requires a thorough history, physical examination, x-rays and often a CT or MRI scan.

Nonsurgical treatment of sciatica which includes non-steroidal anti-inflammatory medication, short term narcotic pain medication, physical therapy and occasional lumbar epidural steroid injections, are often effective in relieving symptoms. Patients who do not respond to a four to six week course of conservative treatment or those patients with progressive weakness or sensory deficit should be evaluated by a spine specialist.

If a CT or MRI scan demonstrate nerve root compression due to a disc herniation or spinal stenosis, then surgical intervention may be necessary. Current surgical techniques include microdiskectomy or minimally invasive lumbar laminectomy. These techniques have shown excellent success rates for relieving sciatic pain. Prevention of sciatica includes a healthy diet, regular exercise, weight control and avoidance of smoking.

By Stephen M. Waggoner, M.D. – Dr. Stephen M. Waggoner received his medical degree from East Tennessee State University. He completed his residency at Emory University School of Medicine Department of Orthopaedic Surgery, Atlanta, GA.  He completed a fellowship in spine disorders at the Charlotte Spine Center in Charlotte, NC. His specialties include spinal disorders, adult reconstruction and work-related injuries.  He is board certified in orthopaedic surgery.  He practices at all four MOG locations.