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When discussing sciatica, it is important to understand the underlying medical cause, as effective treatment will focus on addressing the pain’s root cause as well as alleviating acute symptoms.
6 Most Common Causes of Sciatica
The following six lower back problems are the most common causes of sciatica:
- Lumbar herniated disc
A herniated disc occurs when the soft inner material of the disc leaks out, or herniates, through the fibrous outer core and irritates or pinches the contiguous nerve root.
Other terms used to refer to a herniated disc are slipped disc, ruptured disc, bulging disc, protruding disc, or a pinched nerve. Sciatica is the most common symptom of a lumbar herniated disc.
- Degenerative disc disease
While some level of disc degeneration is a natural process that occurs with aging, for some people one or more degenerated discs in the lower back can also irritate a nerve root and cause sciatica.
Degenerative disc disease is diagnosed when a weakened disc results in excessive micro-motion at that spinal level, and inflammatory proteins from inside the disc become exposed and irritate the nerve root(s) in the area.
Bone spurs, which may develop with spinal degeneration, also may press against a nerve, resulting in sciatica.
- Isthmic spondylolisthesis
This condition occurs when a small stress fracture allows one vertebral body to slip forward on another; for example, if the L5 vertebra slips forward over the S1 vertebra.
With a combination of disc space collapse, the fracture, and the vertebral body slipping forward, the nerve can get pinched and cause sciatica.
- Lumbar spinal stenosis
This condition commonly causes sciatica due to a narrowing of the spinal canal. Lumbar spinal stenosis is related to natural aging in the spine and is relatively common in adults older than age 60.
The condition typically results from a combination of one or more of the following: enlarged facet joints, overgrowth of soft tissue, and a bulging disc placing pressure on the nerve roots, causing sciatica pain.
Lumbar spinal stenosis commonly occurs along with spinal arthritis, and arthritis can also cause or contribute to sciatica symptoms.
- Piriformis syndrome
The sciatic nerve can get irritated as it runs under the piriformis muscle in the buttock. If the piriformis muscle irritates or pinches a nerve root that comprises the sciatic nerve, it can cause sciatica-type pain.
This is not a true lumbar radiculopathy, which is the clinical definition of sciatica. However, because the leg pain can feel the same as sciatica or radiculopathy, it is sometimes referred to as sciatica.
- Sacroiliac joint dysfunction
Irritation of the sacroiliac joint—located at the bottom of the spine—can also irritate the L5 nerve, which lies on top of the sacroiliac joint, causing sciatica-type pain.
Again, this is not a true radiculopathy, but the leg pain can feel the same as sciatica caused by a nerve irritation.