Dr Colum Nolan
Senior Consultant Spine & Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)
Leg pain does not always originate in the leg itself. In many cases, the true source of the discomfort is actually in the lower back. The nerves that travel from your spine down into your hips, buttocks and legs can become irritated or compressed at times— and when they do, the pain can radiate along the entire path of the nerve.
This can cause a sharp, shooting, burning or tingling pain that first begins in the back, before travelling down one or both legs. Although this can resemble a hamstring strain, the true cause may be spinal in nature. This type of leg pain is often referred to as sciatica.
What Is Sciatica?
Sciatica refers to pain caused by irritation or compression of the sciatic nerve, the largest nerve in the body. The sciatic nerve begins in the lower spine, formed by several nerve roots, and runs through the buttocks and down the back of each leg to the feet.
When one of the nerve roots in the lower spine becomes compressed, often due to a slipped disc, spinal stenosis or age-related degeneration, it can trigger pain that radiates along the sciatic nerve pathway. This pain typically affects one side of the body and may be accompanied by numbness, tingling or weakness of the limb.
Sciatica is a symptom of an underlying spinal issue rather than a diagnosis on its own. Identifying the exact cause is key to ensuring appropriate treatment and long-term relief.
What Spinal Issues Can Cause Sciatica?
Slipped Disc
A slipped/herniated disc is one of the most common causes of sciatica. When a disc in the lower vertebrae bulges or ruptures, it can press on a nearby nerve root. This compression may trigger pain that travels from the lower back into the buttocks and down the leg.Pinched Nerve (Lumbar Radiculopathy)
Lumbar radiculopathy, often referred to as a pinched nerve in the lower back, occurs when a spinal nerve root becomes compressed or inflamed. This irritation can cause sharp, shooting pain, numbness or weakness that follows the path of the sciatic nerve.Lumbar Stenosis
Lumbar stenosis is a narrowing of the spinal canal in the lower back. As the space around the nerves becomes tighter, pressure can build on the nerve roots that form the sciatic nerve. This may result in leg pain, heaviness or cramping, especially when standing or walking.Slipped Vertebra (Spondylolisthesis)
Spondylolisthesis occurs when one vertebra slips forward over the one below it. This shift can narrow the space where the nerves exit the spine and lead to nerve compression. If the affected nerves contribute to the sciatic nerve, pain may radiate down the leg.How Spine Specialists Diagnose the Cause of Sciatica
Diagnosing the cause of sciatica usually begins with a detailed consultation. A spine specialist will typically take a thorough medical history, asking when the pain started, how it travels, what tends to make it worse and whether there is any numbness or weakness in the leg.
A focused physical examination is then carried out. This may include assessing your posture, spinal movement, muscle strength, reflexes and sensation in the legs. Certain clinical tests may help indicate whether a specific nerve root is irritated.
If nerve compression is suspected, imaging tests such as an MRI scan may be recommended. MRI tends to provide detailed images of the discs, nerves and surrounding structures, which may help identify issues such as a slipped disc, lumbar stenosis or a slipped vertebra.
In some cases, additional tests may be advised to clarify the diagnosis. A careful assessment helps ensure that any treatment plan is directed at the likely underlying spinal cause rather than focusing only on symptom relief.
How Does a Spine Specialist Treat Sciatica After Diagnosis?
Non-surgical and Pain Management Options
For patients with mild to moderate symptoms, or where inflammation is a significant contributor, targeted pain management techniques may help reduce nerve irritation and support recovery.Epidural Injections and Nerve Blocks
Epidural injections involve placing anti-inflammatory medication into the space around the affected nerve root in the lower back. This may help reduce swelling and irritation caused by conditions such as a slipped disc or lumbar stenosis. Nerve blocks work in a similar way by delivering medication around a specific nerve to reduce pain signals. They may also help confirm which nerve is responsible for the symptoms.RF Ablation
Radiofrequency ablation is a procedure that uses controlled heat to interrupt pain signals from small nerves, often those supplying the facet joints of the spine. If facet joint degeneration is contributing to lower back pain alongside sciatica, RF ablation may help reduce this source of discomfort. It does not directly treat disc compression, but it may improve overall pain control in selected patients.Nucleoplasty
Nucleoplasty is a minimally invasive procedure used in selected cases of a contained slipped disc. A small probe is inserted into the disc to reduce internal pressure. By decreasing disc volume, this may lessen the bulge pressing on the nerve root and help relieve sciatic pain in carefully selected cases.Minimally Invasive Surgical Options
If symptoms persist despite conservative care or if imaging shows clear nerve compression, minimally invasive surgery may be considered to directly relieve pressure on the affected nerve.Lumbar Discectomy/Decompression
Lumbar discectomy and decompression are often considered when a slipped disc is clearly compressing a nerve and symptoms continue. These two procedures are distinct, but are often performed together in order to create more space around compressed nerves and relieve pressure in the lower back.Spinal Fusion
Spinal fusion may be considered when sciatica is linked to spinal instability, such as a slipped vertebra. The procedure involves joining two or more vertebrae together to reduce abnormal movement and stabilise the spine. By restoring stability and maintaining adequate space for the nerves, fusion may help relieve ongoing nerve compression in selected cases.
When Should You Seek Further Evaluation for Sciatica?
While some episodes of chronic leg pain may settle with rest and simple measures, persistent, worsening or recurrent symptoms may indicate an underlying spinal condition that requires proper assessment. Visiting a spine specialist can help you receive an accurate diagnosis and place you on the path to effective treatment.
At Oxford Spine & Neurosurgery Centre, we place a focus on identifying the true source of sciatic pain rather than simply managing symptoms. Every patient undergoes a careful clinical evaluation, and treatment is guided accordingly. Our senior consultant spine and neurosurgeon, Dr Colum Nolan, takes a structured and evidence-based approach to assessing back and leg pain, with the aim of clarifying the underlying causes of your pain and smoothly moving forward with clinical intervention.
If you are experiencing ongoing back pain, leg pain, numbness or weakness that is affecting your daily activities, seeking early medical advice may help prevent symptoms from progressing. Contact us today to schedule an appointment.
Our Spine Specialist in Singapore
Dr Colum Nolan
Senior Consultant Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)
Dr Colum Nolan is a senior consultant spine and neurosurgeon, as well as the Medical Director of Oxford Spine & Neurosurgery Centre. He undertook specialist neurosurgery training in Ireland and Australia, and later on completed a complex spine surgery fellowship at Addenbrooke’s Hospital in Cambridge, UK.
Dr Colum held key leadership roles including Director of the Spine and Spinal Disorders Programme at the National Neuroscience Institute (NNI), as well as the Head of Neurosurgery Service at Sengkang General Hospital.
With his depth of experience, Dr Colum is committed to guiding each patient towards the safest and most effective treatment for their needs.
