Sciatica is the inflammation of the sciatic nerve, the most complex and voluminous nerve in our body. The inflammatory process causes acute pain, which runs from the sacral and pelvic areas to the back of the leg. Dr. Maurizio Fornari, Head of Neurosurgery at Humanitas, spoke about sciatica in an interview with Corriere della Sera.


The typical pain of sciatica

Sciatica indicates that there is irritation of a nerve root in the lower back. The typical pain, in fact, originates in the lumbar area and descends along the sciatic nerve, passing along the buttocks and legs, until it reaches the foot. Generally, the pain affects only one side of the body and has an intensity that varies from mild to stabbing. In most cases, sciatica is related to a protrusion or hernia in the disc and the pain is alleviated with the resolution of the cause that determines it.

It should be noted that in the presence of pain in the legs we do not necessarily speak of sciatica. This may be due to vascular problems, muscle tension or irritation of another femoral nerve root, resulting in pain in the anterior part of the thigh (cruralgia).

Symptoms such as tingling, numbness, lack of sensitivity or strength of the foot can also occur; in their presence, there is a suffering of the nerve root and not only an irritation of it.


What are the causes of sciatica?

Some causes of sciatica include:

  • Irritation or compression of a nerve root due to a herniated disc or a protrusion.
  • Shrinkage of the lumbar spinal canal.
  • Pyriform syndrome: a small muscle in which the sciatic nerve passes through its fibers; this can become irritated or compressed as a result of prolonged contractures.


How is the diagnosis made?

The diagnosis makes use of a specialist examination, during which some maneuvers will be carried out (such as the maneuvers of Lasegue and Wasserman) to understand the origin of the disorder.

The practitioner may then suggest further investigations, such as MRI, radiography, CT scan and electromyography.


The treatments

Generally, sciatica resolves in about six weeks without the need for surgery. In some cases, however, such as in the presence of disc hernias that do not resolve, obstructive hernias that compress the nerve root or dural sac, or neurological deficits, surgery (microdiscectomy, laminectomy) may be indicated.

During the acute phase of pain it is advisable to rest in bed with the legs flexed and to combat pain anti-inflammatory drugs, painkillers and muscle relaxants are recommended. Systemic analgesic and cortisonic epidural infiltrations may also be useful. In the sub-acute phase, however, postural manipulation and gymnastics are indicated.

Although not all cases of sciatica can be prevented, leading an active life plays a major role in decreasing the risk of its incidence.