Contents
Introduction
Pain and/or paresthesias in the distribution of the sciatic nerve or an associated lumbosacral nerve root.
- Sciatica is a symptom of an underlying condition and not a disease itself

Aetiology
Spinal causes:
- Herniated lumbar disc with nerve root compression (M/C cause overall, 90% cases)
- Poor posture, trauma, strong rotational movement
- Lumbar spinal stenosis (elderly)
- Narrowing of spinal canal (intravertebral foramen)
- Due to:
- Degenerative bone disorders
- Trauma
- Autoinflammatory conditions (rheumatoid arthritis, etc)
- Spondylolisthesis
- Relative misalignment of one vertebra relative to another
- Lumbar/pelvic muscular spasm and/or inflammation (may impinge a lumbar or sacral nerve)
- Spinal/paraspinal mass (cause mass effect and sciatica symptoms):
- Malignancy
- Epidural hematoma
- Epidural abscess

Non-spinal causes:
- Piriformis syndrome (M/C non-spinal cause)
- Muscle inflammation/spasms causing sciatic nerve compression
- Wallet sciatica (Credit-carditis)
- Wallets in pockets → Pressure on gluteus muscles → Pressure on sciatic nerve
- Pregnancy (vertex presses on sciatic nerve)
- Trauma to leg
- Pelvic tumours
Risk factors:
- Personal factors:
- Age (peak 45-64 years)
- Increasing risk with height
- Smoking
- Mental stress
- Occupational factors:
- Strenuous physical activity (frequent lifting, especially while bending and twisting)
- Driving (including vibration of whole body)
Pathoanatomy
Clinical features
- Aching and sharp leg pain following dermatomal pattern
-
Unilateral leg pain greater than low back pain
-
Pain radiating to foot/toes
-
Numbness and paraesthesia in the same distribution
-
Straight leg raising test induces more leg pain
-
Localised neurology (limited to one nerve root)
-
- Low backache (less severe than leg pain)

Diagnosis
Imaging
MRI:

Differential diagnosis
-
Herniated lumbosacral disc
-
Muscle spasm
-
Nerve root impingement
-
Epidural abscess
-
Epidural hematoma
-
Tumour
-
Potts Disease (spinal tuberculosis)
-
Piriformis syndrome
Management
Pain resolves on its own over time.
Lifestyle changes:
- Hot/cold formentation
-
Avoidance of inciting activities or prolonged sitting/standing
-
Practicing good, erect posture
- Use of proper lifting techniques
- Regular light exercises such as walking, swimming, or aquatherapy
Physiotherapy:
-
Core strength exercises
-
Gentle stretching of the lumbar spine and hamstrings
Medical management:
-
Oral NSAIDs
-
Opioid and nonopioid analgesics (if NSAIDs do not work)
-
Muscle relaxants