Sciatica is one of the most common reasons patients visit our neck and spine specialists. Characterized by pain that radiates from the lower back down through the buttock and into one leg, sciatica affects up to 40% of Americans at some point in their lives. While the pain can be intense and disruptive, the good news is that most sciatica cases improve with conservative, non-surgical treatment.
It is important to understand that sciatica is a symptom, not a diagnosis. The term describes pain along the path of the sciatic nerve, but the underlying cause of that nerve irritation must be identified to develop an effective treatment plan.
At Panorama Orthopedics & Spine Center, we take a multidisciplinary approach to sciatica care, beginning with a thorough evaluation and always prioritizing the least invasive treatment that will provide meaningful relief.
Sciatica refers to pain that originates in the lower spine and travels along the sciatic nerve into the buttock, back of the thigh, and sometimes down into the lower leg and foot. The pain typically affects only one side of the body and can range from a dull ache to a sharp, burning sensation or an electric shock-like jolt.
Because sciatica is a symptom rather than a condition, identifying the specific cause is essential. The sciatic nerve can become compressed or irritated by several different spinal conditions, and each may require a different treatment approach. In clinical practice, we also distinguish between true sciatica, where the sciatic nerve or its roots are directly compressed, and sciatica-like conditions such as piriformis syndrome or sacroiliac joint dysfunction, which can produce similar symptoms through different mechanisms.
The sciatic nerve is the longest and largest nerve in the human body, roughly the diameter of a penny at its widest point. It forms from five nerve roots that exit the lower lumbar and upper sacral spine (L4, L5, S1, S2, and S3). These nerve roots converge within the pelvis to form a single large nerve that passes through the buttock, behind the hip joint, and down the back of each leg.
At the level of the knee, the sciatic nerve divides into two branches: the tibial nerve and the common peroneal (fibular) nerve. Together, these branches provide motor function to the muscles of the lower leg and foot and carry sensory information, including pain, temperature, and touch, back to the brain. This is why compression at the spine can produce symptoms felt anywhere from the buttock to the toes.
Sciatica develops when something compresses, irritates, or inflames the sciatic nerve or the nerve roots that form it. The most common causes include:
Less common causes include spinal tumors, infections, and direct trauma to the lumbar spine. In some cases, diabetes-related nerve damage can mimic sciatica symptoms.
While sciatica can affect anyone, certain factors increase the likelihood of developing it. The condition is most common between the ages of 30 and 75. Additional risk factors include excess body weight, which places increased stress on the lumbar spine; prolonged sitting or a sedentary lifestyle; occupations that require heavy lifting, twisting, or long periods of driving; weak core musculature that provides insufficient support for the spine; diabetes, which can affect nerve health; and tobacco use, which impairs blood flow and can accelerate disc degeneration.
The hallmark of sciatica is pain that radiates from the lower back or buttock down one leg. Patients commonly describe this as a sharp, burning, or electric shock-like sensation. Other symptoms include:
Symptoms typically affect one side of the body. In rare and severe cases, sciatica can cause loss of bowel or bladder control, a condition known as cauda equina syndrome. This is a medical emergency that requires immediate evaluation and treatment.
Diagnosing sciatica begins with a detailed medical history and a physical examination. During the exam, your provider will assess your muscle strength, reflexes, and sensation. Specific tests, such as the straight-leg raise, in which the provider lifts your extended leg while you lie on your back, can help reproduce sciatic symptoms and identify the level of nerve involvement.
If symptoms are severe, persistent, or accompanied by neurological changes such as weakness or numbness, imaging studies are typically ordered. An MRI is the gold standard for visualizing soft tissue structures including discs, nerves, and the spinal cord. X-rays may be used to evaluate bone alignment and rule out fractures or other skeletal abnormalities. In some cases, a CT scan, CT myelogram, or electrodiagnostic testing (EMG and nerve conduction studies) may be recommended to further assess nerve function and pinpoint the source of compression.
For most sciatica patients, non-surgical treatment is effective. Our approach at Panorama begins with conservative measures and progresses only as needed. Initial treatment typically includes:
Surgery is considered when conservative treatment has not provided adequate relief after approximately 6 to 12 weeks, when there is a progressive neurological deficit such as increasing weakness, or in cases of cauda equina syndrome. The most common surgical procedure for sciatica caused by a herniated disc is a minimally invasive microdiscectomy, in which the surgeon removes the portion of the disc that is compressing the nerve through a small incision. This procedure uses specialized instruments and magnification to minimize disruption to the surrounding muscles and tissues, resulting in less post-operative pain and a faster recovery compared to traditional open surgery.
Other surgical options may include a laminectomy or laminotomy to create more space for the nerve, or endoscopic spine surgery for select cases. Your spine surgeon will recommend the procedure best suited to your specific condition and anatomy.
Most sciatica episodes improve within four to six weeks with appropriate conservative care. Even after symptoms resolve, ongoing attention to spinal health is important to reduce the risk of recurrence. We recommend the following preventive strategies:
While mild sciatica may improve on its own, you should schedule an evaluation with a spine specialist if:
At Panorama Orthopedics & Spine Center, our team of spine specialists includes orthopedic spine surgeons, neurosurgeons, interventional pain physicians, and spine-specialized physical therapists. We offer same-day and next-day appointments, convenient locations across the Denver metro area, and complimentary spine MRI reviews to help you understand your diagnosis and explore your treatment options.
If you are experiencing sciatic nerve pain that is interfering with your daily life, the spine care team at Panorama Orthopedics & Spine Center is here to help. We offer same-day and next-day appointments across six Denver metro locations, and our multidisciplinary team of fellowship-trained spine surgeons, physiatrists (interventional pain physicians) and spine-specialized physical therapists will work with you to find the least invasive solution for your condition. To get started, request a complimentary spine MRI review call (303) 233-1223, or schedule an appointment at the location most convenient for you.
