Sciatica: leg pain that starts in the back.
Pain that travels along the sciatic nerve from the lower back into the buttock and down the leg. Something is pressing on a nerve root; finding out what, and whether it needs more than time and therapy, is the point of the first visit.
What sciatica feels like
Most people describe a sharp, burning, or electric pain that runs from one side of the lower back through the buttock and down the back or side of the leg, sometimes into the foot. It is usually one-sided. Numbness, tingling, or a patch of skin that feels “asleep” are common. Sitting, coughing, or bending forward often makes it worse; walking or lying down may ease it. Some people have little back pain at all — the leg is the whole story.
What causes it
The sciatic nerve is formed from nerve roots that leave the lower spine. Anything that crowds one of those roots can produce sciatica. The most common cause in adults under 60 is a herniated disc; in older adults it is more often spinal stenosis or a slipped vertebra (spondylolisthesis). Bone spurs, cysts, and — rarely — tumors or infection can do the same thing.
How it is diagnosed
A careful history and exam usually point to the level of the spine involved — which nerve root is irritated shows up in where the pain goes, which reflexes are affected, and which muscles are weak. An MRI is ordered when symptoms are severe, are not improving after several weeks, or there is weakness, because MRI shows the discs and nerves directly. X-rays help when instability or alignment is a question.
Treatment without surgery
For most people, sciatica from a disc herniation improves over roughly six to twelve weeks, though the course varies. Staying active within the limits of pain, a short course of anti-inflammatory medication, and physical therapy aimed at the specific cause are the mainstays. A targeted epidural steroid injection can calm an inflamed nerve root while the body reabsorbs the disc material. Bed rest beyond a day or two tends to slow recovery rather than help it.
When surgery is considered
Surgery is offered mainly when leg pain persists or worsens despite good non-surgical care, when there is progressive weakness in the leg or foot, or — urgently — when there is new bladder or bowel dysfunction or numbness in the saddle area. For a disc herniation the usual operation is a microdiscectomy: removing the fragment that is pressing on the nerve through a small incision. For stenosis it is a decompression (laminectomy). Dr. Mushlin’s published research on lumbar disc herniation focuses on identifying which patients benefit most when surgery is the right choice, and his practice favors the least invasive technique that can do the job safely.
Where to be seen
Dr. Mushlin sees patients at the Stony Brook Spine Institute offices in Riverhead, Lake Grove, and Commack, across Suffolk County. Bring any MRI or X-ray reports you already have; if imaging is needed it can be arranged locally.
Ready to have it looked at? Request an appointment or call 631-444-1213.
How long does sciatica last?
Most episodes from a disc herniation improve substantially within six to twelve weeks with activity and therapy. Pain that lasts longer than that, or that keeps returning, is a reason to be evaluated and to consider imaging.
Is sciatica an emergency?
Usually not. It becomes urgent if you develop new weakness in the leg or foot, numbness around the groin or inner thighs, or any change in bladder or bowel control. Those symptoms need same-day evaluation. Back pain with fever, after a recent infection, or in someone with a weakened immune system should also be seen promptly, since spinal infection can mimic sciatica.
Do I need an MRI for sciatica?
Not always. Many people improve before imaging would change anything. An MRI is worth getting when symptoms are severe, are not improving after several weeks of treatment, or there is weakness — or when surgery is being considered.
Does Dr. Mushlin treat sciatica in Riverhead, Lake Grove, and Commack?
Yes. He sees patients with sciatica and other lumbar conditions at all three Stony Brook Spine Institute offices in Suffolk County.