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Sciatica is one of the most common diagnoses assigned to patients with low back pain. It usually happens in age groups of mid-30s to mid-40s and is associated with lifting heavy objects.
Patient usually experience pain in low back radiating in the leg below the knee. Pain is associated with numbness and tingling in the leg. There may be weakness in the leg. The iteology is mechanical pressure of herniated disc or bone or a combination. The characteristic of pain is sharp shooting, moderate to severe depending upon the nature of compression.
The evaluation begins with a complete history, physical examination, and imaging study, usually MRI confirming the diagnosis. A nerve conduction and EMG study may be required in selective group of patients to differentiate a pinch nerve in the spine vs. peripheral nerve damage in the extremities.
Pain in most of the patients with sciatica settles down in 4-6 weeks with conservative measures including anti-inflammatory medications, physical therapy, and extension and stabilization treatment. If pain persists beyond 4-6 weeks, a selective group may benefit from epidural steroid injection or selective nerve root block. If the pain is unbearable for the patients they can proceed to epidural or oral steroid treatment and follow up with physical therapy. Patient may need 1-3 epidural steroid injections for the resolution of painful symptoms. If patient fails epidural steroid, it is warranted a surgical consult.