Sciatica is inflammation of the sciatic nerve which is a large nerve connecting the L4-S3 levels and exiting the spinal canal through the piriformis muscle travelling down the hamstrings to the calf and foot. This can be irritated for many reasons including: a lumbar disc herniation, osteoarthritis in the spinal canal, spinal stenosis (narrowing the spinal canal), spondylolisthesis (step-off deformity) or scoliosis.
Pain or numbness in the buttock, thigh and possible radiation into the foot. Weakness in the leg or foot may be noted. Activities such as walking and standing may be painful.
When my leg pain may not be from sciatica, also known as pseudosciatica?
Pseudosciatica can be caused by trochanteric bursitis, neuropathy, piriformis syndrome.
On physical exam, a straight leg raise may be positive. Imaging will usually include X-rays to rule out a tumor or fracture and to look at the structure of the lumbar spine (i.e. evaluate for the presence of scoliosis, spondylolisthesis, etc.). To identify the reason for sciatica, MRI is the best imaging. MR imaging can show if there is a disc herniation, osteoarthritis, spinal stenosis or other structural changes contributing to a nerve pinch.
Non-surgical treatments include a trial of medications including anti-inflammatories, oral steroids, muscle relaxers and neuropathic medications like Neurontin to help with the nerve excitability.
Physical therapy can also be helpful to improve range of motion through the spine, correct muscle imbalances and strengthen the core muscles.
Epidural steroid injections
If there is no significant improvement with physical therapy and anti-inflammatories, a lumbar epidural steroid injection may be indicated. This is fluoroscopically guided procedure to deliver steroids at the site of inflammation. It may take more than one to help.
If debilitating pain or weakness continues despite non-surgical treatments it may be time to see a surgeon.
There are many conditions that can present like sciatica with pain or numbness in the buttock, thigh or leg.