What is sciatica?
The sciatic nerve is the largest nerve in the human body, formed from nerve roots that exit the lower spine and travel through the buttock and down the back of each leg. 'Sciatica' is the umbrella term for the symptoms, typically sharp, burning, or shooting pain, that occur when one of those nerve roots is irritated or compressed. Identifying the cause is the key step: imaging plus a focused exam tells us whether the problem is a disc, stenosis, spondylolisthesis, or something else entirely.
Anatomy
Five nerve roots from the lumbar and sacral spine combine to form the sciatic nerve. Compression most commonly occurs at the L4-L5 or L5-S1 level, producing the classic pattern of pain shooting from the lower back through the buttock and down the leg. The specific pattern of symptoms helps localize which nerve root is affected.
What are the symptoms of sciatica?
- Sharp, burning, or shooting pain from the lower back through the buttock and down one leg
- Numbness or tingling in the buttock, leg, foot, or specific toes
- Weakness in the leg or foot, including foot drop
- Pain worsened by sitting, coughing, sneezing, or bending forward
- Difficulty walking or finding a comfortable position
What causes sciatica?
- Lumbar herniated disc (most common)
- Lumbar spinal stenosis
- Spondylolisthesis
- Piriformis syndrome (a non-spinal cause)
- Less commonly, tumors or infections
Who is at risk?
- Age 30 to 50 for disc-related sciatica; older for stenosis-related sciatica
- Sedentary lifestyle or prolonged sitting
- Heavy lifting or repetitive twisting
- Smoking, obesity, and diabetes
How is sciatica diagnosed?
Diagnosis begins with a careful history and a neurologic examination: checking strength, sensation, reflexes, and provocative maneuvers like the straight-leg-raise test. MRI is the imaging study of choice and confirms the underlying cause in the great majority of cases.
When to see a spine surgeon
Most cases of sciatica improve within 6–12 weeks of conservative care. Seek urgent evaluation for severe or progressive weakness, foot drop, numbness in the groin or saddle area, or any change in bowel or bladder function, as these can indicate cauda equina syndrome, a surgical emergency.
How is sciatica treated without surgery?
Treatment depends on the root cause. First-line care includes physical therapy, anti-inflammatories, brief activity modification, and image-guided selective nerve root or transforaminal epidural injections. The majority of patients recover with this approach.
When is surgery needed?
Surgical relief for sciatica targets the underlying nerve compression directly. In most cases, I treat that with an endoscopic decompression, a small-incision procedure that relieves the pinched nerve, with many patients feeling immediate leg-pain relief on waking from surgery. When sciatica is driven by significant instability or severe arthritic changes, traditional teaching is to add a fusion, but in my endoscopic practice I can often still treat these patients endoscopically and avoid fusion altogether.
Common questions
How long does sciatica usually last?
Most cases improve within 6 to 12 weeks with conservative care: physical therapy, anti-inflammatories, brief activity modification, and image-guided injections when needed.
What causes sciatica?
Sciatica is a symptom, not a diagnosis. The most common cause is a lumbar herniated disc, followed by spinal stenosis and spondylolisthesis. Non-spinal causes such as piriformis syndrome are less common, which is why identifying the underlying cause with a focused exam and MRI is the key step.
When should I worry about sciatica?
Seek urgent evaluation for severe or progressive weakness, foot drop, numbness in the groin or saddle area, or any change in bowel or bladder function. These can indicate cauda equina syndrome, a surgical emergency.
What surgery fixes sciatica?
Surgery targets the underlying nerve compression directly. In most cases that means an endoscopic decompression, a small-incision procedure that relieves the pinched nerve; many patients feel leg-pain relief immediately after surgery.
Related procedures
Endoscopic Microdiscectomy / Laminectomy
Endoscopic spine surgery is among the least invasive ways to address disc herniations and spinal stenosis in the lumbar spine.
Endoscopic TLIF
A next-generation lumbar fusion that combines the structural goals of a traditional TLIF with the tissue-sparing advantages of endoscopic surgery.
Related conditions
Endoscopic treatment options
Many patients with sciatica can be treated through incisions of about 7 to 10 mm using endoscopic spine surgery. Dr. Kazarian performs the two-portal endoscopic technique, and explains how it compares with uniportal endoscopy. Whether an endoscopic approach fits your case depends on your imaging and symptoms; see the candidacy guide.
This page is for general educational purposes and is not medical advice. Diagnosis and treatment recommendations require an in-person evaluation. To schedule a consultation with Erick R. Kazarian, MD, please book an appointment.