Sciatica
Sciatica Overview
Sciatica is a medical condition characterized by pain that radiates from the lower back down the leg. The pain may affect the back, outside, or front of the leg, and is often described as shooting. Symptoms typically occur on one side of the body, though some causes may produce pain on both sides. Lower back pain, weakness, or numbness in parts of the leg and foot may also occur.
Causes
About 90% of sciatica cases are due to a herniated spinal disc pressing on a lumbar or sacral nerve root. Other possible causes include:
Spondylolisthesis
Spinal stenosis
Piriformis syndrome
Pelvic tumors
Pregnancy
Conditions with similar symptoms include hip diseases and early herpes zoster (before rash formation).
Diagnosis
The straight-leg-raising test is commonly used. It is positive if raising the leg while lying on the back causes pain below the knee. Medical imaging is usually not needed unless:
Bowel or bladder function is affected
Significant loss of sensation or weakness occurs
Symptoms are persistent
Tumor or infection is suspected
Epidemiology
Prevalence: Less than 1% to 40%, depending on definition
Most common in people in their 40s and 50s
Men are more frequently affected than women
Treatment
Initial approach: Pain medications and maintaining normal activity as much as possible
Recovery: About 90% of people experience symptom resolution within six weeks
Surgery: Considered for severe pain lasting over six weeks or complications like loss of bowel/bladder control
Other treatments (steroids, gabapentin, pregabalin, acupuncture, heat/ice, spinal manipulation) have limited or weak evidence
History
The condition has been known since ancient times. The term “sciatica” was first used in 1451.
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