Sciatica

• Age (peak 45-64 years)
• 
  Increasing risk with height
• 
  Smoking
• 
  Mental stress
• Strenuous physical activity—for example, frequent lifting, especially while bending and twisting
• 
  Driving, including vibration of whole body

Sciatica is mainly diagnosed by history taking and physical examination. By definition patients mention radiating pain in the leg. Sciatica is characterised by radiating pain that follows a dermatomal pattern. Patients may also report sensory symptoms.

Diagnostic imaging is only useful if the results influence further management. In acute sciatica the diagnosis is based on history taking and physical examination and treatment is conservative (non-surgical). Imaging may be indicated at this stage if there are ‘red flags’. Diagnostic imaging may also be indicated in patients with severe symptoms who fail to respond to conservative care for 6-8 weeks. In general the clinical course of acute sciatica is favourable and most pain and related disability resolves within 4 to 6 weeks. However up to 30% patients may continue to have pain for one year or longer

• Pain in the buttock or leg up to the foot
• Burning or tingling
• Sharp, shooting pain
• Weakness and numbness in the leg
• Pain worse with bending and walking
• Pain exacerbated by coughing and sneezing

• Painkillers including specific medication that works on nerve pain ( Anti neuropathic drugs)
• Injections (Nerve root blocks, epidural injections)
• Surgery (microdiscectomy)

• Confirmation of diagnosis (MRI scan)
• Management of pain (pain killers, specific medications, interventional treatments)
• Nerve root block for diagnosis and therapeutic benefit
• Rehabilitation (Physiotherapy)
• Referral to Neurosurgeon if indicated