Sciatica

Question 1

What is sciatica?

Answer 1

Radicular pain caused by irritation/compression of the lumbrosacral nerve roots (L4-S1)

Question 2

Roots of sciatic nerve

Answer 2

L4-S3

Question 3

2 MC nerve roots in sciatica

Answer 3

L5 and S1

Question 4

MC cause of sciatica and in older adults

Answer 4

Lumbar disc herniation
Older: spinal stenosis

Question 5

Presentation of sciatica

Answer 5

Radicular pain radiating from the lower back → buttock → down the posterior/lateral leg below the knee

Question 6

What makes sciatica worse?

Answer 6

1. Coughing
2. Sneezing
3. Straining
4. Bending forward
5. Prolonged sitting

Question 7

5 red flags in sciatica

Answer 7

1. Bilateral weakness
2. Saddle anaesthesia
3. Urinary R/incontinence
4. Faecal incontinence
5. Weight loss

Do MRI of spine (especially if sx > 6 weeks)

Question 8

Mx of sciatica

Answer 8

1. NSAIDs
2. Physiotherapy
3. Neuropathic pain meds - TCA, SNRI, gabapentin
4. Steroid injections
5. Surgery

Question 9

Do most cases of sciatica resolve spontaneously?

Answer 9

Yes - most improve within 6-12 weeks

Poor prognosis - long duration of sx or structural spinal pathology