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BJA Advance Access originally published online on August 17, 2007
British Journal of Anaesthesia 2007 99(4):461-473; doi:10.1093/bja/aem238
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 BJA: October 2007
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management

M. A. Stafford1, P. Peng2,* and D. A. Hill1

1 Department of Anaesthesia, Ulster Hospital, Dundonald, Upper Newtownards Road, Belfast BT16 1RH, Ireland
2 Wasser Pain Management Centre, Mount Sinai Hospital, 600 University Avenue, Toronto, Canada M5G 1X5

* Corresponding author. E-mail: philip.peng{at}uhn.on.ca

Radicular pain in the distribution of the sciatic nerve, resulting from herniation of one or more lumbar intervertebral discs, is a frequent and often debilitating event. The lifetime incidence of this condition is estimated to be between 13% and 40%. Fortunately, the majority of cases resolve spontaneously with simple analgesia and physiotherapy. However, the condition has the potential to become chronic and intractable, with major socio-economic implications. This review discusses the history, epidemiology, pathophysiology, and natural history of sciatica. A Medline search was performed to obtain the published literature on the sciatica, between 1966 and 2006. Hand searches of relevant journals were also performed. Epidemiological factors found to influence incidence of sciatica included increasing height, age, genetic predisposition, walking, jogging (if a previous history of sciatica), and particular physical occupations, including driving. The influence of herniated nucleus pulposus and the probable cytokine-mediated inflammatory response in lumbar and sacral nerve roots is discussed. An abnormal immune response and possible mechanical factors are also proposed as factors that may mediate pain. The ongoing issue of the role of epidural steroid injection in the treatment of this condition is also discussed, as well as potential hazards of this procedure and the direction that future research should take.

Keywords: analgesic techniques, epidural; analgesics anti-inflammatory, steroid; pain, neuropathic; pain, pathological; spinal cord, vertebral space


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