Sciatica

Definition
Sciatica is a symptom complex characterised by pain radiating along the sciatic nerve pathway — from the lower back through the buttock and down the back of the leg — usually caused by nerve root compression or irritation in the lumbar spine.

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Causes

• Lumbar disc herniation (most common)

• Degenerative lumbar spine disease (spondylosis, spinal stenosis)

• Spondylolisthesis

• Spinal tumours or infections (rare)

• Piriformis syndrome (extra-spinal nerve entrapment)

• Pregnancy (due to posture and mechanical pressure)

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Risk Factors

• Age 30–50 years

• Sedentary lifestyle

• Heavy lifting or twisting at work

• Obesity

• Prolonged sitting

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Pathophysiology

• Compression or irritation of one or more lumbosacral nerve roots (commonly L4, L5, S1)

• Leads to neuropathic pain, sensory changes, and sometimes motor weakness in the affected dermatome/myotome distribution

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Clinical Features

• Pain: sharp, burning, or shooting, radiating from lower back to foot

• Unilateral in most cases

• Worse with coughing, sneezing, prolonged sitting

• Possible numbness, tingling, or weakness in leg/foot

• Positive straight leg raise test

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Red Flag Symptoms (urgent referral)

• Bilateral sciatica

• Saddle anaesthesia

• Bladder or bowel incontinence/retention

• Severe or progressive motor weakness
  (May indicate cauda equina syndrome)

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Diagnosis

• Clinical based on history and examination

• MRI lumbar spine: gold standard to detect disc herniation or stenosis

• CT myelography if MRI not possible

• Nerve conduction studies in unclear cases

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Treatment

Self-Care & Conservative Measures (first-line)

• Maintain activity as tolerated (avoid prolonged bed rest)

• Heat or ice packs for pain relief

• Gentle stretching and physiotherapy

Medications

• Paracetamol 500–1000 mg every 4–6 hours (max 4 g/day)

• NSAIDs: Ibuprofen 400 mg every 8 hours or Naproxen 250–500 mg twice daily (short-term, if no contraindications)

• Neuropathic pain agents: Amitriptyline 10–25 mg at night or Gabapentin 300 mg TID, titrated as tolerated

• Short course of oral corticosteroids in selected acute cases (e.g., prednisolone taper)

Interventional

• Epidural steroid injections for persistent radicular pain

• Surgical decompression (e.g., microdiscectomy) if:

  • Severe or progressive neurological deficit

  • Persistent pain >6–8 weeks despite conservative therapy

  • Cauda equina syndrome (emergency)

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Prevention

• Regular exercise to strengthen back and core muscles

• Proper lifting technique

• Maintain healthy weight

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Quick-Reference Clinical Chart — Sciatica

Feature	Details
Definition	Pain radiating along sciatic nerve due to lumbar nerve root compression
Common Causes	Lumbar disc herniation, spinal stenosis, spondylolisthesis, piriformis syndrome
Risk Factors	Age 30–50, sedentary lifestyle, heavy lifting, obesity
Symptoms	Unilateral leg pain, numbness/tingling, weakness, worse with sitting/coughing
Red Flags	Bilateral symptoms, saddle anaesthesia, bladder/bowel dysfunction
Diagnosis	Clinical ± MRI lumbar spine
First-Line Treatment	Maintain activity, physiotherapy, paracetamol, NSAIDs
Second-Line	Neuropathic pain meds, epidural steroid injections
Surgical Indications	Severe neuro deficit, refractory pain, cauda equina syndrome
Prognosis	Most recover within weeks; surgery may be needed if severe or persistent