Sciatica is pain resulting from irritation, impingement, or compression of the spinal nerve roots in the spine.

Causes: 

Sciatica can be caused by a variety of factors, ranging from minor issues to more serious conditions such as:

– Prolapsed intervertebral disc: the most common cause

– Degenerative disc disease

– Spinal stenosis

– Spondylolisthesis

– Osteoarthritis

– Trauma

– Tumours

– Piriformis syndrome

Presentation:

It can vary based on the underlying cause and may include the following:

• Lower back pain associated with hip and leg pain that extends to the feet
• Isolated leg pain that radiates to the feet
• Increased pain during movement or mobility limitations
• Legs may buckle, feel cold, or experience a lack of sensation
• Sharp, shooting, electric sensations or burning feelings
• Pins and needles, numbness in the legs
• Cauda Equina: loss of bladder or bowel control and perineal numbness

Assessment and Diagnosis:

To effectively understand and treat sciatica, a thorough evaluation is essential for identifying the underlying cause. This includes the following components:

• Comprehensive History and Assessments
• Investigation: MRI, CT Scan, Nerve Conduction Study
• Follow-up for the Personalised Multimodal Management Plan
• Review of the Agreed Tailored Pathway Outcomes

Multimodal Treatment:

Treatment varies depending on the underlying cause and may include:

• Initiation of oral analgesics, including anti-neuropathic agents
• Physiotherapy for core muscle strengthening exercises
• Spinal injections to the nerve roots, including transforaminal epidural and caudal epidural
• Radiofrequency pulsing of the spinal nerve roots
• Surgical opinion, if necessary