Sciatica is defined as a severe pain in a leg along the course of the sciatic nerve. The pain is felt in the back of the leg running from the buttock down the back of the thigh into the calf and foot. The sciatic nerve is the longest and largest nerve in the body; it measures three-quarters of an inch in diameter. It originates in the sacral plexus; a network of nerves in the low back (lumbosacral spine). The lumbosacral spine refers to the lumbar spine and the sacrum combined. The sciatic nerve and its nerve branches enable movement and feeling (motor and sensory functions) in the thigh, knee, calf, ankle, foot, and toes.
The pain may begin abruptly or gradually, and is characterized by a sharp, shooting, or electric shock-like quality.
Movement of the extremity (ie, leg) often intensifies the pain.
Pain may be uniformly distributed along the leg, but frequently there are certain spots where pain is more intense.
Pain is often associated with numbness and/or tingling in the distribution of the sciatic nerve.
Sciatica may result from any process which causes pressure or irritation of the nerve roots which compromise the sciatic nerve. This pressure may result from a variety of processes such as a ruptured intervertebral disc, narrowing of the bony spinal canal (called spinal stenosis), or rarely from infection or tumor.
The sciatic nerve is the longest and largest nerve in the body; it measures three-quarters of an inch in diameter. It originates in the sacral plexus; a network of nerves in the low back (lumbosacral spine). The lumbosacral spine refers to the lumbar spine and the sacrum combined. The sciatic nerve and its nerve branches enable movement and feeling (motor and sensory functions) in the thigh, knee, calf, ankle, foot, and toes. The sciatic nerve and the lumbosacral spine is pictured below.
About the Sciatic Nerve in the Low Back The sciatic nerve starts in your low back, which is called your lumbar spine. The nerve roots are at the L4 and L5 vertebrae (the 'L' means lumbar, and the numbers indicate the level of the vertebra—where it is in your back). The sciatic nerve also travels through your pelvic region (sacrum).
In most people, the sciatic nerve runs under the piriformis muscle, which moves your thigh side to side. From there, the sciatic nerve descends through the buttocks and the back of the thighs. Behind your knee, smaller nerves branch out from the sciatic nerve and travel down to your feet.
Your sciatic nerve is part of a complex structure: your body's nervous system. That system is responsible for transmitting pain and sensation to other parts of your body. So, when something presses on a nerve, you'll feel it, and it won't feel good. With sciatica, something in your low back—a herniated disc, for example—compresses the sciatic nerve, which then transmits pain down your legs.
The sciatic nerve exits the sacrum (pelvic area) through a nerve passageway called the sciatic foramen. At the upper part of the sciatic nerve, two branches form; the articular and muscular branches. The articular branch goes to the hip joint. The muscular branch serves the leg flexor muscles (muscles that enable movement).
Other complex nerve structures are involved—the peroneal nerves and tibial nerves. The peroneal nerves originate from the nerve roots at the fourth and fifth lumbar spine (L4-L5) and first and second levels of the sacrum (S1-2). After the peroneal nerves leave the pelvis, they travel down the front and side of the leg, and along the outer side of the knee, to the foot.
The tibial nerves originate from the nerve roots at L4-5 and S1-3. The tibial nerves pass in front of the knee and downward into the foot (heel, sole, toes).
If your sciatic nerve is compressed, it can cause pain along these pathways; that is how sciatic pain can "spread" or radiate to another part of your body.
What's causing my pain? Your sciatic nerve pain can be caused by a bulging disc or a herniated disc, degenerative disc disease, piriformis syndrome, pregnancy, spinal stenosis, a spinal tumor or spinal infection, spondylolisthesis, or trauma.
Any one of those conditions can put pressure on the sciatic nerve or related nerve roots in your low back. That pressure is what causes your pain and other symptoms.
Will I need surgery? Most patients with lumbar radiculopathy respond well to non-surgical treatments, so spine surgery is seldom needed to treat it. However, there are situations when you may want to go ahead with spine surgery:
You have bowel or bladder dysfunction. This is rare, but it may occur with spinal cord compression.
You have spinal stenosis, and your doctor feels that surgery is the best way to treat it.
You are experiencing other neurologic dysfunctions, such as severe leg weakness.
Your symptoms become severe and/or non-surgical treatment is no longer effective.
What kinds of surgery are used for lumbar radiculopathy? Two common spinal surgeries for sciatica are:
discectomy or microdiscectomy: In both of these procedures, the surgeon removes all or part of a herniated disc that's pushing on your sciatic nerve and causing your symptoms. The difference between the procedures is that a microdiscectomy is a minimally invasive surgery. The surgeon uses microscopic magnification to work through a very small incision using very small instruments. Because the surgery is minimally invasive, you should recover more quickly from a microdiscectomy.
laminectomy or laminotomy: These procedures both involve a part of the spine called the lamina—a bony plate that protects the spinal canal and spinal cord. A laminectomy is the removal of the entire lamina; a laminotomy removes only a part of the lamina. These procedures can create more space for the nerves, reducing the likelihood of the nerves being compressed or pinched.
Can I use over-the-counter medication to deal with my pain? Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) will help reduce swelling while relieving your pain. You and your doctor have plenty to choose from. You can use acetaminophen (eg, Tylenol), ibuprofen (eg, Advil), or naproxen (eg, Aleve).