Lumbar Radiculopathy, Disc Herniation & Sciatica New York City| Dr. Zeeshan Sardar

Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C
Director, Quality & Patient Safety (QPS) – Och Spine Hospital
Medical Director, Spine Unit – Och Spine Hospital
Co-Chief of Spinal Deformity Surgery • NewYork-Presbyterian / Columbia University
Och Spine Hospital • New York, NY

Sciatica is one of the most common and most misunderstood pain syndromes. It specifically refers to pain caused by compression or irritation of a lumbar nerve root — most commonly by a herniated lumbar disc. Understanding the cause of your leg pain is essential for choosing the right treatment. Most patients improve without surgery. For those who don’t, surgical decompression is highly effective.

WHAT IS LUMBAR RADICULOPATHY?

Lumbar radiculopathy is pain, numbness, tingling, or weakness caused by compression of a nerve root as it exits the lumbar spine. The term “sciatica” refers specifically to symptoms from compression of the L4, L5, or S1 nerve roots, which together form the sciatic nerve and travel from the lower back down the buttock, thigh, calf, and foot.

WHAT CAUSES IT?

  • Lumbar disc herniation — the most common cause in younger patients; the soft inner disc material ruptures and presses on the adjacent nerve root
  • Lumbar spinal stenosis — narrowing of the spinal canal from degenerative changes; more common in older patients
  • Foraminal stenosis — narrowing of the opening through which the nerve exits the canal
  • Spondylolisthesis — forward slip of one vertebra creating nerve root compression

WHICH LEG IS AFFECTED?

  • L4 root (L3–4 disc) — pain into the thigh and inner calf, knee reflex diminished, quadriceps weakness
  • L5 root (L4–5 disc) — pain into the outer calf and top of foot, foot drop in severe cases
  • S1 root (L5–S1 disc) — pain into the outer foot and heel, ankle reflex diminished, calf weakness

DIAGNOSIS

MRI is the primary diagnostic study, identifying the herniated disc, level and degree of nerve root compression, and any associated pathology. CT myelography is used when MRI is not possible. Electrodiagnostic studies (EMG/NCS) can confirm the diagnosis and assess degree of nerve injury.

NON-SURGICAL TREATMENT

  • Physical therapy — the cornerstone of non-surgical treatment; core strengthening, lumbar stabilization, and directional exercises
  • Anti-inflammatory medications (NSAIDs, oral steroids) — for acute pain episodes
  • Lumbar epidural steroid injections — can provide meaningful temporary relief of radicular pain, facilitating recovery and participation in physical therapy
  • Activity modification — avoiding activities that worsen nerve compression while maintaining general fitness

WHEN IS SURGERY INDICATED?

  • Failure of conservative treatment after 6–12 weeks of appropriate management
  • Progressive neurological deficit — worsening foot drop, expanding weakness
  • Cauda equina syndrome — bladder or bowel dysfunction from massive central herniation; a surgical emergency
  • Severe, intractable pain significantly impairing quality of life

SURGICAL OPTIONS

  • Lumbar microdiscectomy — the gold standard surgical treatment; removes the herniated fragment causing nerve compression; leg pain relief in over 90% of appropriately selected patients
  • Lumbar disc replacement — for selected patients with lumbar DDD where motion preservation is desirable and candidacy criteria are met
  • Lumbar fusion — when instability, spondylolisthesis, or recurrent herniation after prior discectomy makes fusion the more appropriate option

FREQUENTLY ASKED QUESTIONS

Is sciatica the same as a herniated disc?

Not exactly. Sciatica is the symptom (pain radiating along the sciatic nerve), while a herniated disc is one common cause of it. Other conditions like stenosis or spondylolisthesis can also cause sciatica.

How long does sciatica typically last?

Many episodes improve within 6 to 12 weeks with conservative treatment. Symptoms that persist beyond this point, or that progressively worsen, warrant a more thorough evaluation.

What is foot drop and is it serious?

Foot drop is weakness lifting the front of the foot, caused by significant nerve root compression. It is a more urgent symptom than pain alone and generally warrants prompt evaluation.

Can sciatica come from something other than the spine?

True sciatica originates from the lumbar nerve roots, but other conditions, such as piriformis syndrome or hip pathology, can mimic similar symptoms. A thorough evaluation helps distinguish the actual source.

Do I need surgery if I have sciatica?

Most patients with sciatica improve without surgery. Surgery is considered for those who don’t improve with conservative treatment, or who have progressive neurological symptoms.

WHY CHOOSE DR. SARDAR

Dr. Sardar evaluates every patient with lumbar radiculopathy individually and offers the full range of treatment options. His goal is always the least invasive approach that reliably achieves meaningful, durable relief.

This page is for educational purposes only and does not constitute individualized medical advice.

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