Sciatica

Sciatica is a symptom, not a diagnosis. It describes electric, radiating pain that travels from the lower back or buttock down one leg, often past the knee. The cause is irritation or compression of a lumbar nerve root — most commonly L5 or S1.

The most common underlying problem is a herniated disc that contacts the nerve. Other causes include foraminal stenosis (narrowing where the nerve exits the spine), spondylolisthesis, or, less often, a synovial cyst or tumor.

I take a careful history and do a focused exam — strength testing, reflexes, sensation, and the straight-leg raise. An MRI of the lumbar spine confirms which level is involved and which nerve root is compressed.

The good news: roughly 80–90% of sciatica resolves over six to twelve weeks with conservative care alone. Time, activity modification, physical therapy, anti-inflammatories, and sometimes an epidural injection get most patients better.

The decision to operate is rarely about the imaging alone. It's about whether your symptoms match what we see, whether they're improving, and whether your function is being significantly limited.

Surgery becomes the right answer when leg pain is severe and unresponsive to several weeks of appropriate conservative care, when there is progressive motor weakness, or — rarely — when cauda equina syndrome develops (loss of bowel or bladder control, saddle numbness). That last one is an emergency: call 911.

For the right patient, microdiscectomy provides immediate and durable relief. It is one of the highest-success operations in all of spine surgery, with most patients walking the same day and back to desk work within two weeks.