Sciatica

Symptoms and red flags

Typical sciatica is a sharp or burning pain that starts in the lower back or buttock and runs down one leg. It is often worse after sitting for a while, and a cough or sneeze can send a jolt down the leg. Patients may also feel tingling or numbness in the calf or foot, and some notice that the foot feels weak or drags when they walk.

Some signs mean the nerve is in danger and you should see a doctor the same day:

• Weakness in the foot or leg that is new or getting worse
• Numbness around the back passage or the inner thighs
• Difficulty passing urine, or loss of control of the bladder or bowel
• Pain in both legs at once, or pain together with fever or unexplained weight loss

These can point to severe pressure on several nerve roots at once, and waiting can cost function that does not come back.

Causes and who gets it

A lumbar disc herniation is by far the most common cause, usually at the lowest two levels of the spine, which carry the most load. Narrowing of the spinal canal with age, called spinal stenosis, can squeeze the same nerves, and here the leg pain tends to come on with walking and ease on sitting. Less often the cause is a slipped vertebra, a fracture, an infection or a tumour, which is why a proper examination matters even when the story sounds typical.

Sciatica is most common between the thirties and the fifties, when discs are still soft enough to bulge but have begun to wear. Heavy lifting, long hours of driving, desk work without breaks, smoking and being overweight all add to the strain. Young people can get it after a sudden twist or lift, and older patients more often from stenosis.

How it is diagnosed

The consultation starts with your story: where the pain goes, what brings it on, and whether there is numbness or weakness. Dr. Salman Falak then examines the back and the legs. He checks the reflexes and the power in each muscle group, and tests the feeling in the skin of the leg and foot. He also raises the straight leg to see whether stretching the nerve brings on the pain. This examination usually tells him which nerve root is involved before any scan is done.

An MRI of the lumbar spine is the test that shows a disc pressing on a nerve, and it is needed before any talk of surgery. X-rays show bone alignment and are useful if instability or a fracture is suspected. If you already have scans, bring them or send them on WhatsApp before your visit, so that the discussion can start from the picture itself. Nerve conduction studies are occasionally added when the scan and the examination do not match.

Treatment: conservative care first, then surgery

Most sciatica settles on its own over some weeks. The first line of treatment is medicine for the pain and the nerve irritation, with physiotherapy once the worst of it eases. Staying gently active helps more than bed rest. Some patients benefit from a targeted injection around the nerve root, which can calm the inflammation and buy time for the disc to shrink.

Surgery is considered when a fair trial of conservative care has failed, and sooner when the leg is weakening or the red flags above appear. The standard operation is lumbar disc herniation surgery, in which the fragment of disc pressing on the nerve is removed. Dr. Salman Falak performs this through a small incision under the microscope, and in suitable cases through an even smaller cut with an endoscope. Which technique fits you depends on the position and size of the herniation, and he explains the choice at the consultation.

What recovery looks like

With conservative treatment, leg pain usually improves over a few weeks, and numbness can take longer to fade. After a disc operation, the leg pain is often much better when the patient wakes, because the pressure on the nerve is gone. Most patients walk on the day of surgery and go home within a day or two. Desk work usually resumes within a few weeks, and heavy lifting waits longer. A nerve that has been squeezed for months can stay numb or tingly for a while after it is freed, and this is not a sign that the operation has failed.

When to see a neurosurgeon

See a neurosurgeon if leg pain has lasted more than a few weeks despite medicine, or if there is any numbness or weakness. You do not need to wait for a referral. Many patients from Gujranwala, Faisalabad, Kasur and further afield start with a video consultation and send their MRI on WhatsApp, so that the visit to Lahore, if one is needed at all, is planned properly. Dr. Salman Falak also holds an OPD in Gujranwala on Fridays and in Phool Nagar on Tuesdays.

Related procedures

If the cause is a slipped disc, the page on lumbar disc herniation surgery explains what the operation involves and what recovery looks like. The pages on microscopic spine surgery and endoscopic spine surgery describe the two ways the same disc can be reached through a small cut, and who is suited to each. Patients whose back pain is worse than the leg pain should read about chronic back pain, because the treatment path is different.