Non Spine Causes of Sciatica

Sciatica is the pinched nerve feeling in the back that causes back pain with a radiating pain to the hips to the legs.  As an Orthopaedic Spine Specialist,  it is probably the most common complaint of my patients. In the most simplest definition,  sciatica is a pinching of the nerve that goes from the spine into the legs.

Dr. Bennett D. Grimm, MD, and Associates  of OrthoCarolina wrote a wonderful review of the topic in the Journal of the American Academy of Orthpaedic Surgeons.

The review article confirms that the most common causes for sciatica are herniated disks or bone spurs in the back. The sciatic nerve components are pinched within the spine with disk herniations and spine bone spurs.  There are sciatica conditions that are caused by pinching outside the spine.  There are also conditions that cause sciatica complaints not related to the spine.

Non Spine Causes of Sciatica include:

  1. Hip arthritis.  Problems with the hip joints including arthritis,  bursitis,  sacroilitis can cause similar back and thigh pains.
  2. Reduced blood supply.  Some patients have narrowing of the blood supply in the arteries to the legs.  With activities such as exercise,  or walking,  it may cause pain to the legs.
  3. Tumors.  This one usually gets peoples attention.  On rare occasions,  the pinched nerve sensation is secondary to a tumor (benign or cancerous) that grows in the pelvis,  and pinches the nerves as the nerve travels outside the spine canal into the legs.  The Spine bone,  is connected to the hip bone,  which connects to the thigh bone, and so on.  Likewise,  the nerves go from your spine,  past the hips,  into the legs.  A tumor located outside the spine,  can pinch the nerve as it travels to the leg.
  4. Peripheral Neuropathy.  Certain medical conditions such as diabetes  causes damage to the nerves outside the spine.  This damage to the outside the spine is Peripheral Neuropathy.
  5. Outside Nerve Compression.  As stated above,  the sciatic nerve components travel outside the spine,  into the legs.  Sometimes,  muscles,  ligaments,  and collections of fluids,  called cysts can also cause pinching of the nerve components.   These nerves can also be compressed by  swelling of the tissues from a trauma,  or infection.
  6. Iliac artery aneurysms (a bubble like weakness in the wall of the artery) can also get large enough to cause the same compression symptoms as above.

Fortunately,  most episodes of sciatica resolve,  or improve with time.  On the other hand,  increasing pain,  weakness, and numbness may mean a continuing worsening process.  If you have concerns,  please have it evaluated by your physician.

Citations

  • Jeon IC, Kim SW, Jung YJ. Large sized common iliac artery aneurysm with thrombus developing a diagnostic confusion in a patient with sciatica. Korean J Pain. 2014 Oct;27(4):360-4. PubMed PMID: 25317286

Hi, I'm Dr. John Shim, and I'd like to talk about sciatica-like complaints that do not come from the spine. In my other videos I've discussed the true nature of sciatica, and how it's a shooting-type pain that comes from irritations of the nerves in the lower back. It typically causes a shooting pain that originates from the lower back, travels down the buttock along the back of the thigh, and then radiates into the calves and into the toes. Most of the time its caused by a pinching of the nerve either by a disc herniation or a spine bone spur, but this sciatica-type feeling is not always related to lower back nerves. People often confuse any shooting-type pain with sciatica. In reality, things like hip arthritis can cause these complaints. Hip arthritis presents in many ways, and some will confuse that pain with sciatica. That groin pain that shoots to your thigh is more indicative of a hip arthritis than a sciatica. For some people, after walking for a certain distance they'll feel weakness to their legs, and sometimes a tingling. They can also think that's a sciatica. In reality, this can be a sign of a blood flow issue to the legs, and not necessarily sciatica. For other people, there's also pinching of the components of the sciatic nerve, but it happens outside the spine. That pinching can occur at the buttock or at the knee or even at the leg. So, if you have radiating symptoms, but it seems to localize more to one of those areas, It may not be a sciatic condition from the back, but rather specifically to the nerve. There's also a final complaint that's a little bit more serious. Some people are complaining of constant abdominal pain that starts developing pain radiating down the legs. On rare occasions, and thank God its rare, a tumor in the stomach can cause entrapment of the nerves outside the spine causing sciatic-type complaints. We also have medical conditions such as diabetes that can cause nerve impairments, and people might confuse that for sciatica. I hope I'm not scaring you with all this information, but if you have sciatica, and if it does not go away... ...besides looking at just the spine, your doctors may need to consider other reasons for that pinched nerve feeling in your legs. I'm Dr. John Shim. I hope I provided a little bit more information on how doctors view your complaints of shooting leg pains. If concerned, please contact your doctor. Thank you.

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