Sciatica - questions and answers

Sciatica (lumbar radiculopathy) is lower back or buttock pain radiating to the legs. It can also be associated with numbness or weakness in the leg.

The most common cause of sciatica is a herniated disc in the lumbar spine causing irritation or compression to the spinal nerves roots forming the sciatica nerve supplying the leg. 

Other causes of sciatica include

• Spinal stenosis
• Spondylolithesis
• Piriformis syndrome
• Pelvic injury or fracture
• Pregnancy
• Cancer
• Infection
• Nerve disorders
• Idiopathic

Sciatica is common and studies have shown that between 13% and 40% of people develop sciatica at some stage during their lifetime.

In the vast majority of people sciatica is self limiting and not serious. 

However, people with sciatica are advised to seek urgent medical attention if they have any of the following symptoms as they can be suggestive of possible cauda equina syndrome which may require urgent surgical intervention.

• Sciatica on both sides
• Severe weakness or numbness in both legs
• Numbness around genitals or anus
• Difficulty passing urine
• Loss of bowel control

If you have any of the above, please contact 999 immediately or attend your local Emergency Department.

Sciatica generally gets better without intervention or surgery within a few months, but for a significant number of people it can last a lot longer and in some cases it persist indefinitely.

Imaging is not required in all cases of sciatica, however in some patients it is very useful as it can confirm the diagnosis and help with treatment options, either with epidural injections to reduce the symptoms or with spinal surgery to relieve the nerve compression.

If a spinal MRI is required our partner The LivingCare Group can arrange this at convenient time and at a competitive price.

If sciatica is caused by nerve irritation from a herniated disc that has not quickly resolved a targeted epidural of local anaesthetic and steroid may be indicated. This is because it can help reduce the painful symptoms and allow people engage with exercise and return to work and their normal activities. The epidural generally lasts for several months and it is hope that in this time frame the sciatica will have started to settle naturally.

In a small number of cases surgery is required, either acutely because of concerning symptoms or electively because of symptoms that have failed to resolved with conservative measures.

The Yorkshire Clinic are highly experienced in the management of sciatica and our consultants are involved in the NHS spinal treatment service for Leeds including providing the spinal injections and epidurals for sciatica.

Our assessment will cover a number of core areas to identify the cause of sciatica

• History of pain and its effect on function, well-being and quality of life
• Investigation, treatments and interventions already received
• Medication history
• General medical history
  

Following this, an individualised plan will be made on how to proceed and may include:

• Advice
• Medication changes
• Epidural injections
• Investigations - Spinal MRI or other
• Referral to physiotherapy and/or spinal surgery