Sciatica

When the pain starts, sharp and electric, radiating from the lower back through the buttock and down the leg, most patients immediately search for answers. Some fear permanent nerve damage. Others worry they are heading straight to surgery. The good news, backed by decades of research and the experience of NJBS fellowship-trained neurosurgeons: the majority of sciatica cases improve with conservative treatment, and surgery is rarely the first step in care.

WHAT IS SCIATICA?

Sciatica is pain caused by irritation, compression, or inflammation of the sciatic nerve, the longest and widest nerve in the human body. The sciatic nerve originates from several nerve roots (L4, L5, S1, S2, and S3) in the lower lumbar spine, travels through the buttock, and runs down the back of each leg. When any portion of this nerve pathway is compressed or irritated, pain can radiate anywhere along its course, from the lower back to the foot.

The term “sciatica” describes a symptom pattern rather than a single diagnosis. The underlying cause of that nerve irritation determines the most appropriate treatment, which is why accurate diagnosis matters as much as symptom relief.

Sciatica is extraordinarily common, affecting roughly 40% of Americans at some point during their lives. It is most frequently seen in adults between ages 30 and 60, though it can occur at any age.

SYMPTOMS OF SCIATICA

Sciatica symptoms typically affect 1 side of the body. The most common signs include:

• Sharp, burning, or electric pain that radiates from the lower back through the buttock and down the back of the leg (and sometimes into the foot)
• Numbness or reduced sensation along the course of the sciatic nerve
• Tingling or pins-and-needles sensation, especially in the foot or toes
• Muscle weakness in the affected leg or foot
• Pain that worsens with prolonged sitting, coughing, sneezing, or leaning forward
• Pain that may improve briefly when walking or changing position

Red flags requiring immediate evaluation include sudden severe weakness in the leg, loss of sensation in the inner thigh or saddle area, or loss of bladder or bowel control. These symptoms may indicate cauda equina syndrome, a rare but serious emergency. If you experience these, seek care immediately.

COMMON CAUSES OF SCIATICA

Sciatica develops when a nerve root in the lumbar spine is compressed or irritated. The most frequent causes include:

Herniated Disc: The most common cause of sciatica in younger adults. When the soft inner material of a spinal disc (nucleus pulposus) pushes through a tear in the outer ring, it can press against an adjacent nerve root. A herniated disc at L4-5 or L5-S1 most often produces classic sciatic symptoms down the leg.

Spinal Stenosis: Narrowing of the spinal canal or the nerve root exit openings (foramina) compresses the nerves that form the sciatic nerve. Spinal stenosis is the most common cause of sciatica in adults over 50 and typically causes symptoms that worsen with walking or standing and improve with sitting or leaning forward.

Degenerative Disc Disease: As spinal discs lose height and moisture with age, the foramina through which nerve roots exit the spine can narrow. Degenerative disc disease often coexists with other causes of sciatica and can contribute to nerve root irritation without a discrete disc herniation.

Spondylolisthesis: A condition in which 1 vertebra slips forward on the one below it, potentially compressing nerve roots. This is particularly common at L4-5 and L5-S1.

Piriformis Syndrome: Less commonly, the sciatic nerve can be irritated as it passes near or through the piriformis muscle in the buttock. This form of sciatica does not originate from the spine and is diagnosed differently.

Other causes include spinal tumors, epidural cysts, and pregnancy-related changes that increase pressure on the lumbar spine and sciatic nerve.

WHO IS AT RISK?

Several factors increase the likelihood of developing sciatica:

• Age between 30 and 60 years, when disc degeneration is most active
• Sedentary lifestyle or occupation requiring prolonged sitting
• Jobs involving heavy lifting, twisting, or whole-body vibration
• Obesity, which adds mechanical load to the lumbar spine
• Diabetes, which increases susceptibility to nerve irritation
• Prior low back injury or a history of spinal conditions

HOW NJBS DIAGNOSES SCIATICA

At New Jersey Brain and Spine, evaluation begins with a thorough clinical assessment, not with imaging alone. NJBS neurosurgeons gather a complete history of your symptoms, including when they began, what makes them better or worse, and how they affect daily activities.

A detailed neurological examination assesses:

• Muscle strength in the legs and feet
• Sensation along specific nerve distributions (dermatomal patterns)
• Deep tendon reflexes (knee and ankle)
• Straight leg raise test, which can reproduce sciatic symptoms when positive

When the clinical picture warrants further evaluation, particularly when symptoms have not improved after 4 to 6 weeks or when neurological deficits are present, NJBS uses advanced imaging to identify the structural cause:

• MRI: The preferred imaging tool for evaluating disc herniation, spinal stenosis, and nerve compression. MRI provides detailed visualization of soft tissue, discs, and nerve structures.
• CT scan or CT myelogram: Used when MRI is contraindicated or when bony anatomy needs more detailed assessment.
• Electromyography (EMG) and nerve conduction studies: Help confirm nerve dysfunction and identify which specific nerve roots are affected, particularly in cases where imaging and clinical findings do not align.

Imaging findings must always be interpreted in the context of your symptoms. Many adults have disc changes visible on MRI that cause no symptoms at all, and treatment decisions are always based on the full clinical picture.

TREATMENT OPTIONS FOR SCIATICA

The great majority of sciatica cases, estimated at 80% to 90%, improve without surgery. NJBS follows a conservative-first approach for every patient.

Non-Surgical Treatment

Activity Modification: Brief rest (24 to 48 hours) followed by a gradual return to normal activity is appropriate in the acute phase. Prolonged bed rest is not recommended and can delay recovery.

Physical Therapy: Exercise-based therapy targeting core stabilization, lumbar flexibility, and nerve mobilization is more effective than rest alone for most patients. A physical therapist familiar with nerve root syndromes can design a program specific to your diagnosis and functional goals.

Medications: NSAIDs (ibuprofen, naproxen) reduce inflammation and are typically the first-line pharmacologic option for mild to moderate sciatica. For severe acute pain, short courses of oral corticosteroids or muscle relaxants may be appropriate. Neuropathic agents such as gabapentin are used for persistent nerve-type pain in selected patients.

Epidural Steroid Injections: When sciatica pain is severe or when it has not responded adequately to oral medications and physical therapy, an epidural steroid injection delivers anti-inflammatory medication directly to the affected nerve root. Injections do not cure the underlying structural problem but can provide meaningful pain relief and allow patients to engage more effectively in physical therapy.

When Is Surgery Considered?

Surgery for sciatica is considered when:

• Conservative treatment has been pursued for at least 6 to 12 weeks without adequate relief
• Neurological deficits are present or worsening, including significant leg weakness or sensory loss
• Pain is severe and disabling enough to substantially impair quality of life
• Cauda equina syndrome develops (requires urgent surgical intervention)

The most common surgical procedures used to treat sciatica at NJBS include:

• Microdiscectomy / Minimally Invasive Discectomy: For sciatica caused by a herniated disc pressing on a nerve root. A small portion of the herniated disc is removed to decompress the nerve. Most patients experience significant pain relief within days to weeks.
• Laminectomy: For sciatica caused by spinal stenosis, a laminectomy removes a portion of the bony arch (lamina) to create more space for the nerve roots.
• Discectomy: Removal of disc material compressing a nerve root. Discectomy is often performed as a minimally invasive procedure with a short recovery time.

For detailed information about the available surgical and non-surgical approaches, see our full Sciatica Treatment Options.

FREQUENTLY ASKED QUESTIONS ABOUT SCIATICA

SCHEDULE A CONSULTATION

NJBS serves patients across northern New Jersey and the greater tri-state area, with offices in Paramus, Hackensack, Montclair, Montvale, Annandale, and Englewood.  No referral is required to schedule a consultation.

Schedule a consultation or request a second opinion today.