Sciatica (Lumbar Radiculopathy)
Sciatica is a symptom, not a diagnosis. It describes pain traveling down the leg along the sciatic nerve, and the cause is almost always in the spine: a nerve root being compressed or inflamed by a disc herniation, a narrowed canal, or a slipped vertebra. Finding which is the first step to treating it well.
What sciatica actually is
The sciatic nerve is formed by nerve roots that leave the spine in the low back. When one of those roots is compressed or inflamed, pain is felt along the nerve's path rather than at the spine itself. That is why sciatica can be severe in the calf while the back barely hurts.
The cause depends largely on age. In younger and middle-aged adults, a herniated disc is by far the most common reason. In older adults, narrowing of the spinal canal or the openings where the nerves exit (spinal stenosis) is more likely, and the pain is often felt in both legs with walking. A vertebra that has slipped forward (spondylolisthesis) can cause either pattern.
What helps
The large majority of sciatica improves without surgery. Early on, the most useful steps are staying active within comfort, a short course of anti-inflammatory medication, and physical therapy directed at the low back and nerve mobility. Bed rest beyond a day or two tends to slow recovery.
For pain severe enough to block sleep, work, or therapy, an epidural steroid injection delivers anti-inflammatory medication directly around the irritated nerve. It does not fix the underlying cause, but it frequently buys enough relief for natural healing to finish the job. Dr. Michael offers injections and nonsurgical care in the office when surgery is not needed.
When to see a spine surgeon
Seeing a spine surgeon does not commit you to surgery. It is appropriate when leg pain has lasted more than a few weeks, when there is numbness or weakness, when pain is not responding to initial care, or when you want a clear explanation of what is causing it. The evaluation includes an examination to identify the nerve involved and imaging when it will change the plan.
Go to the emergency department, rather than waiting for an appointment, if you develop new trouble controlling your bladder or bowels, numbness in the groin or inner thighs, or leg weakness that is getting worse over hours or days.
Surgical options
When surgery is appropriate, the operation is matched to the cause. A herniated disc is treated with a microdiscectomy, a small outpatient operation that removes the fragment pressing on the nerve. Stenosis is treated with a decompression (laminectomy or laminotomy) that opens the space around the nerves, often through a minimally invasive approach. When a slipped vertebra is unstable, the decompression is combined with a fusion, frequently a minimally invasive TLIF using navigation or robotic guidance for screw placement.
Leg pain tends to respond well to surgery when the nerve compression is clearly the cause. Back pain by itself is less predictable, which is one reason careful patient selection matters more than the technique.
Common questions
How long does sciatica last?
Most episodes improve meaningfully within six to twelve weeks. Symptoms that last longer, keep returning, or come with weakness warrant a spine evaluation.
Is walking good for sciatica?
Generally yes. Gentle walking and staying active within comfort help most people recover faster than rest. If walking consistently brings on leg pain that eases when you sit or lean forward, that pattern suggests spinal stenosis and is worth mentioning at your visit.
Can sciatica be treated without surgery?
Usually. Activity, medication, physical therapy, and injections resolve the majority of cases. Surgery is reserved for persistent disabling pain, progressive weakness, or emergencies.
Does Dr. Michael treat sciatica without surgery?
Yes. Dr. Michael provides nonsurgical care and spinal injections in the office, and recommends surgery only when the evidence and your goals point that way.