Sciatica: real causes, symptoms that matter and when to see a specialist

Sciatica is one of the most used, and most misunderstood, terms when people talk about pain in the lower back and legs.

What is sciatica?

Sciatica is the group of symptoms that appear when the sciatic nerve, the longest nerve in the body, is irritated or compressed. This nerve starts in the lower spine and runs down the back of the leg to the foot. It is not a diagnosis in itself: it is the sign of a problem that needs to be identified.

What causes sciatica?

The most common cause is a herniated lumbar disc, especially at the L4-L5 or L5-S1 levels, where the displaced disc presses on a nerve root. Other causes include:

• Stenosis, or narrowing of the lumbar canal.
• Degenerative changes in the joints of the spine.
• Less often, problems outside the spine that affect the path of the nerve.

What are the symptoms of sciatica?

The typical symptom is pain that goes from the lower back or buttock down the back of the thigh and leg, sometimes to the foot. It can feel burning, stabbing or like an electric shock, with tingling or numbness. Many people notice it gets worse when sitting, coughing or straining.

Which signs mean sciatica is serious?

Muscle weakness is the main warning sign: trouble lifting the foot when walking, standing on tiptoe or bearing weight. Loss of bladder or bowel control is an emergency and needs immediate care.

When should I see a neurosurgeon for sciatica?

Many people improve with conservative treatment within weeks or months. An evaluation with a neurosurgeon is indicated when:

• The pain is severe and does not respond to initial treatment.
• Weakness is progressing.
• There are changes in bladder or bowel control.
• Your quality of life is seriously affected.

How is it diagnosed and treated?

An MRI of the lumbar spine is the study of choice to find the cause and the affected level. With that information a tailored plan is made, which can range from medication and rehabilitation to minimally invasive procedures or surgery, depending on the case.

In summary

Sciatica treated in time has a good outlook in the vast majority of patients. The most common mistake is waiting for it to go away on its own: when there is weakness, every week of delay can mean more damage to the nerve.

This article is for information only and does not replace a medical visit. If you have warning signs, go to the emergency room.