What it is
Sciatica describes pain radiating along the sciatic nerve's territory — from the lower back or buttock down the back of the leg, sometimes to the foot. It almost always means a nerve root in the lumbar spine is being irritated or compressed, most often by a disc herniation or stenosis. The good news: most cases improve without surgery, typically over six to twelve weeks.
Common symptoms
- Sharp, shooting, or burning pain down one leg
- Numbness or tingling in the leg or foot
- Weakness in the foot or ankle
- Pain worse with sitting, coughing, or sneezing
- Urgent signs: progressive weakness, numbness in the saddle area, or bladder/bowel changes — seek immediate care
Why it happens
The most common cause is a herniated lumbar disc pressing on a nerve root. Spinal stenosis, spondylolisthesis, and, rarely, other causes of nerve compression can produce the same picture. The examination and imaging together identify which nerve, at which level, and why — which determines the right treatment.
How Dr. Pompliano evaluates it
Every evaluation starts with listening — a detailed history of your symptoms, how they behave, and how they limit your life — followed by a focused physical and neurological examination and a careful review of your imaging. The diagnosis drives the plan, not the other way around.
Treatment: conservative first
Most patients with this condition improve without surgery. Depending on your specific situation, a plan may include:
- Time and guided activity: most disc-related sciatica improves substantially within 6–12 weeks — staying appropriately active beats bed rest
- Physical therapy: nerve-mobilizing and core-stabilizing programs tailored to your presentation
- Medication: short courses of anti-inflammatories; nerve-pain agents in selected cases
- Epidural steroid injections: can meaningfully reduce pain while the underlying irritation settles
Surgery is recommended only when symptoms persist despite a genuine course of conservative care, or when there are signs of progressive nerve or spinal cord compromise.
When surgery makes sense
Surgery — most often a minimally invasive microdiscectomy — is considered when significant leg pain persists despite conservative care, or sooner when there is progressive weakness. For the right patient, relief of leg pain is often rapid.
Related procedures: Microdiscectomy · Decompression