Sciatica
Introduction
Sciatica is a medical condition characterized by pain radiating along
the path of the sciatic nerve, which extends from the lower back
through the hips and down each leg. It most commonly affects only
one side of the body at a time. Understanding its pathology and
physiology is crucial for diagnosis, management, and treatment.
Physiology of the
Sciatic Nerve Origin: The sciatic nerve originates from the
lumbosacral plexus, primarily from L4–S3 nerve roots.
Course: It exits the pelvis through the greater sciatic
notch, passes beneath the piriformis muscle, travels
down the posterior thigh, and branches into the tibial
and common peroneal nerves at the popliteal fossa.
Function: The sciatic nerve is responsible for motor
and sensory innervation to the posterior thigh, most of
the lower leg, and the foot.
Pathology of Sciatica
Herniated Disc: The most common
cause, where intervertebral disc Spinal Stenosis: Narrowing of the
material compresses one of the spinal canal, leading to nerve
nerve roots that form the sciatic compression.
nerve.
Degenerative Disc Disease: Age- Piriformis Syndrome: Compression
related changes in spinal discs that by the piriformis muscle in the
might impinge nerve roots. buttock.
Pathophysiology
Nerve Root Compression: Any mechanical pressure or
chemical irritation from nearby structures can lead to
inflammation.
Inflammatory Cascade: The compressed nerve root releases
inflammatory mediators, leading to pain, swelling, and
sometimes functional loss.
Demyelination: Chronic compression can result in loss of the
myelin sheath, impairing nerve conduction.
Ischemia: Blood supply to the nerve may be reduced,
exacerbating symptoms and potentially leading to chronic
pain.
Pain: Sharp, burning, or shooting pain
radiating from the lower back or
Clinical Features
buttock down the leg.
Paresthesia: Numbness, tingling, or
weakness along the distribution of the
sciatic nerve.
Reflex Changes: Reduced ankle jerk or
knee jerk reflexes.
Motor Weakness: Difficulty in foot
dorsiflexion (foot drop) or plantar
flexion.
Signs and Symptoms of Sciatica
Pain radiating from lower back down one leg: The classic feature is pain starting in
the lower back or buttock and travelling down the back of the thigh and calf, often
reaching the foot or toes. This pain is usually felt on one side of the body.
Sharp, burning, or electric shock-like pain: The pain can vary in nature—mild ache,
sharp sensation, burning feeling, or “zap” of electricity.
Tingling (“pins and needles”) and numbness: These sensations, similar to a body part
“falling asleep,” commonly affect the leg or foot.
Muscle weakness: Weakness in the affected leg or foot, sometimes described as the
leg “feeling heavy”.
Worse with certain positions or activities: Sitting, sneezing, coughing, or
moving may aggravate the pain.
Difficulty moving or standing: Sciatica pain can make walking and standing
challenging. In some cases, there may be inability to bend the knee or move
the foot and toes.
Rare but serious symptoms: Loss of control over bowels or bladder, or severe
weakness, may indicate serious nerve involvement and requires urgent medical
attention.
Associated back pain: While sciatica often involves leg pain, some patients
may also have less severe back pain.
Diagnosis of Sciatica
[Link] Evaluation
History and Physical Exam: The physician will ask questions about pain
onset, location, aggravating factors, numbness, and weakness. They assess
muscle strength, reflexes, and functional movement (e.g. walking on
toes/heels, rising from a squat).
Straight-Leg Raise Test: While lying down, the leg is raised to check for
pain radiating below the knee, helping identify nerve root involvement (L4,
L5, S1). Positive test recreates the typical pain.
Neurological Exam: Checking for loss of sensation, strength, or reflexes in
affected leg.
2. Imaging and Tests
X-Ray: May identify bone spurs or
spinal changes affecting nerve roots.
MRI: Provides detailed images of soft
tissue, revealing herniated discs or
nerve impingement.
CT Scan (or CT myelogram):
Sometimes used, especially if MRI is
contraindicated.
Electromyography (EMG): Assesses
nerve and muscle function, can
confirm severity of nerve root injury.
2. Red Flag Symptoms
Immediate imaging/testing may be done if
sciatica is accompanied by:
Sudden leg weakness/numbness
Loss of bladder or bowel control
Pain after major trauma (e.g., traffic,
accident)
Fever, swelling, or redness in back
Summary Table: Cause and Effects
Cause Pathological Effect Clinical Manifestation
Herniated Disc Nerve root compression Radicular pain, paresthesia
Spinal Stenosis Root and cord compression Bilateral symptoms, weakness
Piriformis Syndrome Nerve entrapment Buttock/lower limb pain
Spondylolisthesis Vertebral misalignment Back pain, nerve signs
The sciatic nerve is the largest nerve in the
Key Points body and vulnerable to injury/compression,
especially in the lower back and buttocks.
Understanding the physiology and common
pathologies aids proper diagnosis and guides
treatment, which ranges from conservative
management to surgery in severe cases.
Sciatica is a syndrome rather than a distinct
disease, often due to lumbar spine
pathology.
Thank you for
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