Sciatica and Lumbar Radiculopathy
Sharp, electric nerve pain that runs from the lower back through the buttock and down the leg.
Also Called: Lumbar radiculopathy, pinched nerve, nerve root pain.
What It Is
Sciatica is pain that follows the sciatic nerve from the lower back through the buttock and down the leg. It happens when a nerve root in the lower back is compressed or irritated. The cause is usually a herniated disc. Narrowing around the nerve or a slipped vertebra can produce the same pattern.
Causes & Risk Factors
A herniated disc is the most common cause. Age-related narrowing where the nerve exits the spine, or a slipped vertebra, can compress the same nerve. The risk factors are the same as for disc problems: age, heavy or repetitive lifting, smoking, and genetics.
Symptoms
- Sharp, burning, or electric pain starting in the lower back or buttock and running down one leg
- Numbness or tingling in the leg or foot
- Weakness in the leg
- Symptoms typically worsen with sitting, bending, or coughing
Diagnosis
The pattern of pain and numbness down the leg points to which nerve root is involved, before any imaging is reviewed. An MRI then confirms the cause — a herniated disc, narrowing around the nerve, or a slipped vertebra.
Treatment
Most cases of sciatica improve without surgery. Non-surgical care falls into three categories: anti-inflammatory and other pain medications, physical therapy to strengthen the muscles that support the spine, and targeted injections such as an epidural steroid injection. Most patients improve over roughly six to eight weeks.
Surgery is considered when a complete course of non-surgical treatment has not relieved the symptoms, or when weakness or another neurological problem makes waiting inappropriate.
Endoscopic Discectomy
When a herniated disc is the cause, the fragment pressing on the nerve is removed through a dime-sized incision. Most patients go home the same day.
Endoscopic Decompression
When narrowing around the nerve is the cause rather than a disc fragment, the same endoscopic approach opens space for the nerve without disturbing the surrounding muscle and bone.
Minimally Invasive Fusion
Fusion is reserved for cases where a slipped vertebra or an unstable segment is the underlying cause.
Dr. Hirsch is board-certified and Yale-trained. Read his full background.