Sciatica

Sciatica is pain going down the leg from the lower back.^[1] This pain may extend down the back, outside, or front of the leg.^[3] Onset is often sudden following activities such as heavy lifting, though gradual onset may also occur.^[5] The pain is often described as shooting.^[1] Typically, symptoms occur on only one side of the body;^[3] certain causes, however, may result in pain on both sides.^[3] Lower back pain is sometimes present.^[3] Weakness or numbness may occur in various parts of the affected leg and foot.^[3]

About 90% of sciatica is due to a spinal disc herniation pressing on one of the lumbar or sacral nerve roots.^[4] Spondylolisthesis, spinal stenosis, piriformis syndrome, pelvic tumors, and pregnancy are other possible causes of sciatica.^[3] The straight-leg-raising test is often helpful in diagnosis.^[3] The test is positive if, when the leg is raised while a person is lying on their back, pain shoots below the knee.^[3] In most cases medical imaging is not needed.^[2] However, imaging may be obtained if bowel or bladder function is affected, there is significant loss of feeling or weakness, symptoms are long standing, or there is a concern for tumor or infection.^[2] Conditions that can present similarly are diseases of the hip and infections such as early shingles (prior to rash formation).^[3]

Initial treatment typically involves pain medications.^[2] However, evidence for effectiveness of pain medication, and of muscle relaxants, is lacking.^[6] It is generally recommended that people continue with normal activity to the best of their abilities.^[3] Often all that is required for resolution of sciatica is time; in about 90% of cases, symptoms resolve in less than six weeks.^[2] If the pain is severe and lasts for more than six weeks, surgery may be an option.^[2] While surgery often speeds pain improvement, its long term benefits are unclear.^[3] Surgery may be required if complications occur, such as loss of normal bowel or bladder function.^[2] Many treatments, including corticosteroids, gabapentin, pregabalin, acupuncture, heat or ice, and spinal manipulation, have only limited or poor evidence supporting their use.^[3][7][8]

Depending on how it is defined, less than 1% to 40% of people have sciatica at some point in time.^[4][9] Sciatica is most common between the ages of 40 and 59, and men are more frequently affected than women.^[2][3] The condition has been known since ancient times.^[3] The first known modern use of the word sciatica dates from 1451,^[10] although Dioscorides (1st-century CE) mentions it in his Materia Medica.^[11]