Editing Sciatica (section)

{{Short description|Lower-back pain that can extend down the leg}}
{{Infobox medical condition (new)
| name          = Sciatica
| image         = Sciatic nerve2.jpg
| caption       = Anterior view showing the sciatic nerve going down the right leg
| field         = [[Orthopedics]], [[neurology]]
| synonyms      = Sciatic neuritis, sciatic neuralgia, lumbar radiculopathy, radicular leg pain
| pronounce     = {{IPAc-en|s|aɪ|ˈ|æ|t|ɪ|k|ə}} {{respell|sy|AT|ik|ə}}
| symptoms      = [[Pain]] going down the leg from the [[lower back]], weakness or numbness of the affected leg<ref name=NIH2015/>
| complications = Loss of bowel or bladder control<ref name=NIH2014b/>
| onset         = 40s–50s<ref name=NIH2014b/><ref name=NEJM2015/>
| duration      = 90% of the time less than 6 weeks<ref name=NIH2014b/>
| types         =
| causes        = [[Spinal disc herniation]], [[spondylolisthesis]], [[spinal stenosis]], [[piriformis syndrome]], [[pelvic tumor]]<ref name=NEJM2015/><ref name=Valat2010/>
| risks         =
| diagnosis     = [[Straight-leg-raising test]]<ref name=NEJM2015/>
| differential  = [[Herpes zoster|Shingles]], diseases of the hip<ref name=NEJM2015/>
| prevention    =
| treatment     = [[analgesics|Pain medications]], [[surgery]],<ref name=NIH2014b/> [[physical rehabilitation]]
| medication    =
| prognosis     =
| frequency     = 2–40% of people at some time<ref name=Valat2010/>
| deaths        =
}}
<!-- Definition and symptoms -->

'''Sciatica''' is [[pain]] going down the leg from the [[lower back]].<ref name=NIH2015>{{cite web|title=Sciatica|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024494/|access-date=2 July 2015|url-status=live|archive-url=https://web.archive.org/web/20180307160812/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024494/|archive-date=7 March 2018}}</ref> This pain may go down the back, outside, or front of the leg.<ref name=NEJM2015/> Onset is often sudden following activities such as heavy lifting, though gradual onset may also occur.<ref name=FowlerScadding2003>{{cite book|author1=T.J. Fowler|author2=J.W. Scadding|title=Clinical Neurology, 3Ed|url=https://books.google.com/books?id=k56tZUQ8RfkC&pg=PA59|date=28 November 2003|publisher=CRC |isbn=978-0-340-80798-9|page=59}}</ref> The pain is often described as shooting.<ref name=NIH2015/> Typically, symptoms are only on one side of the body.<ref name=NEJM2015/> Certain causes, however, may result in pain on both sides.<ref name=NEJM2015/> [[Lower back pain]] is sometimes present.<ref name=NEJM2015/> Weakness or numbness may occur in various parts of the affected leg and foot.<ref name=NEJM2015/>

<!-- Cause, mechanism, and diagnosis -->
About 90% of sciatica is due to a [[spinal disc herniation]] pressing on one of the [[lumbar nerve|lumbar]] or [[sacral nerve]] roots.<ref name=Valat2010/> [[Spondylolisthesis]], [[spinal stenosis]], [[piriformis syndrome]], [[pelvic tumor]]s, and [[pregnancy]] are other possible causes of sciatica.<ref name=NEJM2015/> The [[straight-leg-raising test]] is often helpful in diagnosis.<ref name=NEJM2015/> The test is positive if, when the leg is raised while a person is lying on their back, pain shoots below the knee.<ref name=NEJM2015/> In most cases [[medical imaging]] is not needed.<ref name=NIH2014b/> However, imaging may be obtained if bowel or bladder function is affected, there is significant loss of feeling or weakness, symptoms are long standing, or there is a concern for [[tumor]] or infection.<ref name=NIH2014b/> Conditions that may present similarly are diseases of the hip and infections such as early [[shingles]] (prior to rash formation).<ref name=NEJM2015/>

<!-- Treatment and prognosis -->
Initial treatment typically involves [[analgesics|pain medications]].<ref name=NIH2014b>{{cite web|author1=Institute for Quality and Efficiency in Health Care|title=Slipped disk: Overview|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|access-date=2 July 2015|date=October 9, 2014|url-status=live|archive-url=https://web.archive.org/web/20170908183135/https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072656/|archive-date=8 September 2017}}</ref> However, evidence for effectiveness of the pain medication and [[muscle relaxant]]s is lacking.<ref name="pmid17585160" /> It is generally recommended that people continue with normal activity to the best of their abilities.<ref name=NEJM2015/> Often all that is required for sciatica resolution is time; in about 90% of people symptoms resolve in less than six weeks.<ref name=NIH2014b/> If the pain is severe and lasts for more than six weeks, surgery may be an option.<ref name=NIH2014b/> While surgery often speeds pain improvement, its long term benefits are unclear.<ref name=NEJM2015/> Surgery may be required if complications occur, such as loss of normal bowel or bladder function.<ref name=NIH2014b/> Many treatments, including [[corticosteroid]]s, [[gabapentin]], [[pregabalin]], [[acupuncture]], heat or ice, and [[spinal manipulation]], have [[Levels of evidence|limited or poor evidence]] for their use.<ref name=NEJM2015/><ref>{{cite journal|last1=Markova|first1=Tsvetio|title=Treatment of Acute Sciatica|journal=Am Fam Physician|date=2007|volume=75|issue=1|pages=99–100|url=http://www.aafp.org/afp/2007/0101/p99.html|url-status=live|archive-url=https://web.archive.org/web/20160202170917/http://www.aafp.org/afp/2007/0101/p99.html|archive-date=2016-02-02|pmid=17225710}}</ref><ref name="pmid29970367">{{cite journal | vauthors = Enke O, New HA, New CH, Mathieson S, McLachlan AJ, Latimer J, Maher CG, Lin CC | title = Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis | journal = CMAJ | volume = 190 | issue = 26 | pages = E786–E793 | date = July 2018 | pmid = 29970367 | pmc = 6028270 | doi = 10.1503/cmaj.171333  }}</ref>

<!-- Epidemiology and history -->
Depending on how it is defined, less than 1% to 40% of people have sciatica at some point in time.<ref name=Valat2010>{{cite journal|last=Valat|first=JP|author2=Genevay, S |author3=Marty, M |author4=Rozenberg, S |author5= Koes, B |title=Sciatica.|journal=Best Practice & Research. Clinical Rheumatology|date=April 2010|volume=24|issue=2|pages=241–52|pmid=20227645|doi=10.1016/j.berh.2009.11.005}}</ref><ref name=Cook2014>{{cite journal | vauthors = Cook CE, Taylor J, Wright A, Milosavljevic S, Goode A, Whitford M | title = Risk factors for first time incidence sciatica: a systematic review | journal = Physiother Res Int | volume = 19 | issue = 2 | pages = 65–78 | date = June 2014 | pmid = 24327326 | doi = 10.1002/pri.1572  }}</ref> Sciatica is most common between the ages of 40 and 59, and men are more frequently affected than women.<ref name=NIH2014b/><ref name=NEJM2015/> The condition has been known since ancient times.<ref name=NEJM2015>{{cite journal|last1=Ropper|first1=AH|last2=Zafonte|first2=RD|title=Sciatica.|journal=The New England Journal of Medicine|date=26 March 2015|volume=372|issue=13|pages=1240–8|pmid=25806916|doi=10.1056/NEJMra1410151}}</ref> The first known modern use of the word ''sciatica'' dates from 1451,<ref>{{cite book|last1=Simpson|first1=John|title=Oxford English dictionary|date=2009|publisher=Oxford University Press|location=Oxford|isbn=978-0199563838|edition=2nd}}</ref> although [[Dioscorides]] (1st-century CE) mentions it in his ''[[de Materia Medica (Dioscorides)|Materia Medica]]''.<ref>Dioscorides, ''Materia Medica'' (2-184, s.v. ''Sinepi''), p. [https://archive.org/details/Dioscorides_Materia_Medica/page/n339/mode/2up 311]</ref>