Sciatica refers to sharp or searing pain in the lower back or buttock that continues along the back of the thigh and into the lower leg and foot, and possibly also tingling, numbness, or weakness.
It is most often due to a herniated lumbar disc, degenerative disc disease, spondylolisthesis, or spinal stenosis.
Nonoperative treatment options include brief periods of rest, pain relieving medication, physiotherapy, acupuncture, and spinal injections.
If symptoms are severe, prolonged (greater than 6 to 12 weeks), or if there is a neurological deficit, surgery may need to be considered. Surgical options include laminectomy and microdiscectomy.
In lumbar spinal stenosis, the spinal nerve roots in the lower back become compressed and patients may experience leg pain with walking, known as neurogenic claudication.
Claudication may also be caused by impaired circulation (vascular claudication). Leg pain from either condition will go away with rest, but with spinal stenosis the patient usually has to sit down for a few minutes to ease the leg pain.
For lumbar stenosis, flexing forward or sitting will open up the spinal canal and relieve symptoms, which will recur if the patient gets back into an upright posture. Numbness and tingling can accompany the pain, but true weakness is a rare symptom of spinal stenosis.
Treatment options considered prior to contemplating surgery include exercise (not a cure, but it is important for patients to remain as active as tolerated), activity modification, epidural injections, and medication.
In cases of advanced spinal claudication, decompressive surgery (laminectomy) may be required. If there is concern of spinal instability, spinal fusion at the time of the decompression may need to be performed.
Generally patients do well after surgery, and are able to increase their activity following recovery from surgery.
The American Academy of Orthopaedic Surgeons (AAOS) is an excellent source of patient information on lumbar spine conditions. Here are some relevant topics: