Sciatica: leg pain that starts in the lumbar spine

Sciatica is pain, and sometimes numbness or weakness, that follows a lumbar nerve root into the leg. A disc herniation is a common reason. Narrowing around the nerve can do the same thing. The back itself is sometimes the quieter part of the picture. People often arrive after weeks of sitting pain, a cough that shoots into the calf, or a leg that feels unreliable on the stairs.

A 1990 study in The Journal of Bone and Joint Surgery looked at lumbar MRI scans in adults who had no back pain. A 2006 paper in JAMA, the Spine Patient Outcomes Research Trial, compared surgery with nonoperative care for a lumbar disc herniation that was causing symptoms. A 2008 paper in Spine followed that same question out to four years.

The 1990 imaging study showed that a lumbar scan can look abnormal in people who feel well. A picture of a disc, by itself, does not prove the cause of leg pain. In the disc herniation trial, people improved with surgery and with nonoperative care. The early advantage of surgery was most noticeable for leg pain, and it narrowed as time passed. That is a reason to match the scan to the examination, not a reason to rush or to wait forever.

The visit starts with the path of the pain. Which toes are numb, which muscle is weak, and what makes the pain travel all point toward a particular nerve. An MRI is useful when the symptoms are lasting, significant, or when an operation is being discussed. Many people improve with time, activity, and therapy. An operation such as a microdiscectomy is a conversation when a disc fragment and the examination agree, and simpler care has not been enough.

A visit can tell whether the pain is sciatica, a hip problem, or something else that only feels similar. It can also decide whether imaging would change the plan. This note is general information and is not a personal treatment plan.