What is it?

Sciatica is pain that radiates along the sciatic nerve, the longest nerve in the human body. It originates in the lower back and travels down through the buttocks, the back of the thigh, to the calf and foot.

In most cases, it is caused by compression or irritation of the lumbar nerve roots (L4, L5, or S1), often due to a herniated disc, foraminal stenosis, osteoarthritis, or post-spinal surgery.

Typical Symptoms

• Sharp, shock-like pain along the leg
• Tingling, burning, or numbness
• Muscle weakness or reduced reflexes
• Worsening pain when sitting or standing for long periods of time
• Sometimes associated with lower back pain

Common causes

aAccording to international literature (Leone et al., 2022), the main causes include:

• Lumbar disc herniation
• Foraminal or central stenosis
• Segmental instability (spondylolisthesis)
• Post-surgical scars with periradicular fibrosis
• Piriformis syndrome (extra-spinal compression of the sciatic nerve)
• Peripheral neuropathy or sciatic nerve inflammation

Diagnosis

• Specialist clinical assessment with targeted neurological tests
• Magnetic resonance imaging (MRI) to visualize discs, spinal canal, and compressions
• In selected cases: electromyography (EMG)

Treatment: Gradual and personalized approach

Conservative therapies (initial stage)

• Nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, oral corticosteroids
• Physical therapy (stretching, strengthening, posture)
• Relative rest and posture training
• TENS

Minimally invasive treatments (if pain persists)

• Epidural injections: cortisone is injected around the inflamed nerve root using X-ray guidance.

Surgery

Only recommended if:

• Progressive neurological deficits
• Pain that is resistant to all other treatments
• Herniated disc with severe compression

Prognosis

Many patients improve without the need for surgery, thanks to targeted treatment. A multimodal approach, based on scientific evidence and tailored to your specific condition, is the key to recovery.