Sciatica/Pinched nerve (lumbar radiculopathy)

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Sciatica is pain in the leg caused by pressure on the nerves in the back (pinched nerves). The formal medical term is lumbar radiculopathy.

As the name implies, originally sciatica was described as pressure on the sciatic nerve causing pain running down the back of the leg. Very often, though, people refer to any pain originating at the level of the back and running down the leg as “sciatica”.

Causes

Sciatica may be caused either by a disc herniation or by narrowing in the spinal canal (spinal stenosis) as a result of arthritis.

It may occur at different levels in the lower back and cause pain in different parts of the leg. There is some variability but in general, pain from L2 through L4 radiates in the front of the leg, irritation of L5 nerve causes pain on the side, and S1 nerve causes pain on the back of the thigh and lower leg.

Nerves may also be pinched below the level of spine, for example “piriformis syndrome.” If there is a question regarding the origin of pain, additional studies may be needed.

Treatment

Most people experience significant improvement of their symptoms within six-to-ten weeks.

There are several treatment options including physical therapy, anti-inflammatory and anti-seizure medications, epidural steroid injections and, in cases of severe and persistent pain, surgery.

Surgery is considered in cases when pain is not improving after 6 weeks, when there is progressive weakness or when there is disturbance of bladder or bowel function. It is directed towards removing pressure from the nerve and, sometimes, stabilizing the spine if there is abnormal motion across spine bones.

Imaging is not typically recommended during the early period (before six weeks) unless there are any of the following warning signs.

Red flags are indicators that a more serious condition may exist and should prompt you to seek qualified medical help sooner. They are:

  • history of high-energy trauma
  • weakness in the legs
  • inability to control bowel or bladder function
  • pain increasing over the course of several days
  • increasing pain at night
  • unexplained fever and chills
  • history of poor bone quality (osteoporosis)
  • history of cancer in other body parts
  • history of IV drug use

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