Sciatica and Pinched Nerve

Sciatica is not a diagnosis in itself. It is a set of symptoms caused by irritation or compression of the sciatic nerve, the longest and widest nerve in the human body. The sciatic nerve originates from several nerve roots in the lumbar spine, joins into a single large nerve, and branches all the way down to the foot. When any part of this nerve is compressed or inflamed, it can produce pain, numbness, tingling, or weakness in the leg.

The pain associated with sciatica is often described as sharp, burning, electric, or like a jolt. It typically affects one side of the body and can range from a dull, persistent ache to sudden, severe discomfort that makes it difficult to sit, stand, or sleep. For some people, certain movements or maneuvers make things worse, like bending forward or coughing. Sometimes the pain radiates down the leg without warning.

A pinched nerve occurs when too much pressure is applied to a nerve by surrounding tissue such as bone, cartilage, muscle, or a spinal disc. In the lower back, the most common culprits are herniated or bulging discs that press against the nerve roots as they exit the spine. Other contributors include arthritis and degenerative disc disease, thickened ligaments that narrow the space around the nerve, bone spurs, and spinal stenosis causing generalized compression in the canal.

Less commonly, sciatica can be triggered by piriformis syndrome, in which the piriformis muscle deep in the buttock irritates the sciatic nerve directly, or by a condition called spondylolisthesis, in which one vertebra slips forward over another. Identifying the exact source of compression is essential to guiding effective treatment.

Sciatica and pinched nerve pain can vary widely from person to person. Common experiences include a burning or shooting pain that travels from the lower back through the buttocks and down the back of the leg, numbness or tingling that moves through the leg, weakness in the affected leg or foot, pain that worsens with prolonged sitting or standing, and difficulty walking or bearing weight comfortably.

In more serious cases, a severely pinched nerve can cause significant motor weakness or, in rare cases, a loss of bladder or bowel control. These symptoms should be treated as a medical urgency. If you are experiencing loss of bladder or bowel control alongside leg pain or progressive weakness, please seek care immediately.

Your evaluation at Premier Neurosurgery will begin with a detailed conversation about your symptoms, their duration, what makes them better or worse, and how they are affecting your daily life. Dr. McCutcheon will also conduct a thorough physical and neurological examination to assess reflexes, strength, sensation, range of motion, and any signs of nerve compression.

In most cases, imaging will be ordered to identify the underlying cause. MRI is typically the most useful tool, as it provides clear images of discs, nerves, and soft tissue. X-rays may be used to evaluate bone alignment and look for fractures or spinal instability. In select situations, CT scans or nerve studies may also be recommended.

The goal is always the same: to understand exactly where and why the nerve is being compressed, so we can create a targeted treatment plan designed around your needs.

Many cases of sciatica improve with conservative care. This may include physical therapy to strengthen supporting muscles and improve flexibility, anti-inflammatory medications or nerve pain medications, epidural steroid injections to reduce inflammation around the nerve, activity modification and postural adjustments, and stretching or manual therapy techniques.

When conservative treatments do not provide adequate relief, or when there is significant nerve compression causing weakness or progressive symptoms, surgery may be recommended. Common surgical options include microdiscectomy to remove the portion of a herniated disc pressing on the nerve, laminectomy to create more space in the spinal canal, or spinal fusion in cases of instability or spondylolisthesis.

Dr. McCutcheon specializes in minimally invasive spine surgery, which can often reduce recovery time, minimize tissue disruption, and support a smoother recovery. The approach is always individualized, taking into account your symptoms, imaging findings, overall health, and personal goals.