Sciatica: What it is, Causes, Symptoms, and Treatment Options

Sciatica is a common medical condition that involves shooting pains running down the leg due to compression of the sciatic nerve found in the upper leg. Between 13 and 40% of people in North America and Western Europe will experience sciatica at some point during adulthood (1). Notably, sciatica refers to the symptom of pain that results from pressure on the nerves of the leg or lower back but doesn't refer to a single underlying disease process or cause (2). As such, several disease processes can cause or contribute to sciatica pain. This article discusses some of the common causes of sciatica, symptoms to watch out for, and treatment options to help ease your pain. It will also outline when to seek care from a Spine Surgeon. For further information on specific treatment options, click on the relevant headers below.

As sciatica results from compression of the nerves running through the leg, the conditions that cause sciatica can be grouped into that cause compression at the root, where the nerve leaves the spine and those that cause compression further down the leg. The former is significantly more common, accounting for over 85% of cases, and includes (2):

• Lumbar Disc Herniation (with nerve root compression)*
• Lumbar Spinal Stenosis
• Spondylolisthesis

Compression in the leg is much less common than compression at the nerve root and typically results from either trauma (direct injury to the nerve) or, more rarely, piriformis syndrome, involving direct compression from the piriformis muscle.

The vast majority of cases of sciatica resolve without intervention, with approximately 87% of patients reporting that their symptoms go away after 2 weeks without treatment (3). For those whose pain does not resolve on its own, conservative treatment with physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), and activity as tolerated will typically be pursued for 6-8 weeks in the absence of "red flag" symptoms. Though sometimes used, acetaminophen has limited evidence for use in sciatica and associated conditions. Other supportive treatments, including chiropractic manipulation and acupuncture, have been frequently used for a myriad of reasons including sciatica though do not have specific evidence for their benefit in this condition (2,3)

For patients with symptoms that persist despite conservative management, epidural steroid injections may provide some pain relief but do not address the underlying cause of pain. Surgery may be pursued for those with progressive weakness or numbness to protect from long-term consequences of nerve compression. Patients with persistent sciatica should discuss available treatment options with a licensed medical professional to determine how to best address their pain.