Conservative treatment of sciatica

1. Big picture

Sciatica means pain radiating from the lower back or buttock into the leg due to irritation or compression of a lumbosacral nerve root, most often L5 or S1. The commonest exam cause is lumbar disk herniation, especially at L4–L5 or L5–S1.

For the final exam, the key point is this:

Conservative treatment is appropriate only when there is radicular pain without emergency neurological signs.

Before treating conservatively, always exclude:

• cauda equina syndrome;
• conus medullaris syndrome;
• progressive or severe paresis;
• bladder or bowel dysfunction;
• saddle anesthesia;
• suspected tumor, infection, fracture, or inflammatory disease.

If any of these are present, this is no longer “simple sciatica”; it becomes an urgent diagnostic and neurosurgical problem.

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