Diagnosing Causes of Sciatica

Sciatica is a painful symptom of a disorder in the lumbar spine. There are a variety of conditions which cause sciatica and the first step in developing a treatment plan is arriving at an accurate diagnosis.

Since trauma, such as one caused by a sports injury, a fall, or involvement in a car accident, can lead to sciatica, obtaining an accurate history is the first step toward diagnosis. The physician may ask you such questions as:
1. When did the pain start?
2. Was there an injury or accident that you recall?
3. How did your pain develop?
4. Describe the pain. Does it radiate down your leg? Is there numbness or tingling?
5. On a scale of 1 to 10, with 10 as the most severe pain, how do you rate yours?
6. What activities make this pain worse? For instance, sitting for long periods of time?
7. Does walking up or down hill make the pain worse?
8. Does coughing, sneezing, or straining increase your pain?
9. Have you tried any form of treatment?
10. What helped relieve your pain?

The physician will complete a thorough physical examination, evaluate your posture, test your range of motion and note any specific movements that cause pain. He will examine your spine, note its curvature and alignment and check for muscle spasms. The physician will test your reflexes, your muscle strength, neurological changes, and pain distribution.

In addition, the following tests may be done:
1. Lab tests for symptoms of infection
2. Spinal X-rays
3. MRI –Magnetic resonance imaging which produces cross-section images of your back to detect tumors, or damage to discs and ligaments.
4. CT scan-Computerized tomography which can identify spinal damage.

The MRI and CT scan are more effective than x-rays at showing the soft tissues in your spine and are helpful in identifying conditions such as a bulging or herniated disc. In addition, your physician may decide additional tests are needed to help in a diagnosis:
1. Bone scan will help identify osteoporosis, vertebral fractures, or infection
2. Discogram in which dye is injected and x-rays are taken to confirm the diagnosis that a disc is causing your pain.
3. Myelogram which shows a spinal canal or spinal cord disorder after an injection of dye and an x-ray or CT scan.

Obtaining an accurate diagnosis of the cause of sciatica pain is not always a simple process. Once the cause of your pain is determined, your physician will be able to develop a treatment plan that is appropriate for your condition.
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