From the Guidelines
A workup for bilateral sciatica should begin with a thorough history and physical examination, focusing on the timing, quality, and radiation of pain, along with any associated neurological symptoms. Initial imaging should include lumbosacral spine X-rays to assess for obvious structural abnormalities, followed by MRI of the lumbar spine which is the gold standard for evaluating nerve compression 1. Laboratory tests including complete blood count, erythrocyte sedimentation rate, and C-reactive protein should be ordered to rule out inflammatory or infectious causes. Electromyography and nerve conduction studies may be necessary to confirm radiculopathy and rule out peripheral neuropathy. Unlike unilateral sciatica which typically results from a herniated disc, bilateral sciatica often suggests central spinal stenosis, cauda equina syndrome, or systemic conditions like diabetes or vitamin B12 deficiency. It's essential to assess for red flags such as bowel or bladder dysfunction, saddle anesthesia, or progressive neurological deficits which would indicate cauda equina syndrome requiring emergency surgical intervention 1. The comprehensive approach is necessary because bilateral symptoms often indicate a more complex or serious underlying condition than unilateral sciatica. Key considerations in the workup include:
- Thorough history and physical examination
- Imaging with lumbosacral spine X-rays and MRI of the lumbar spine
- Laboratory tests to rule out inflammatory or infectious causes
- Electromyography and nerve conduction studies to confirm radiculopathy
- Assessment for red flags indicating cauda equina syndrome or other serious conditions. The most recent and highest quality study 1 supports the use of a comprehensive approach in the workup for bilateral sciatica, emphasizing the importance of a thorough history, physical examination, and diagnostic testing to determine the underlying cause and guide treatment.
From the Research
Bilateral Sciatica Workup
- The workup for bilateral sciatica typically involves a combination of medical history, physical examination, and diagnostic tests to determine the underlying cause of the condition.
- Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for the treatment of sciatica, but their efficacy is still a topic of debate 2, 3.
- A 2016 Cochrane review found that NSAIDs are no more effective than placebo for pain reduction in people with sciatica, but may be more effective for global improvement 2.
- A 2020 Cochrane review found that NSAIDs are slightly more effective than placebo for short-term pain reduction and disability in people with acute low back pain, but the magnitude of the effects is small and probably not clinically relevant 4.
- A 2017 systematic review and meta-analysis found that NSAIDs are no more effective than placebo for pain reduction in people with sciatica, but may be more effective for global improvement 3.
- A 2022 overview of medications for treating low back pain in adults found that NSAIDs may be superior to placebo for reducing pain in people with acute and chronic low back pain, but should be used with caution due to the risk of adverse events 5.
Diagnostic Tests
- Diagnostic tests such as MRI or CT scans may be ordered to confirm the diagnosis and rule out other potential causes of bilateral sciatica.
- Electromyography (EMG) and nerve conduction studies (NCS) may also be used to assess the function of the nerves and muscles in the lower back and legs.
Treatment Options
- Treatment options for bilateral sciatica may include physical therapy, chiropractic care, and pain management with medications such as NSAIDs or muscle relaxants.
- In some cases, surgery may be necessary to relieve compression on the nerves or to stabilize the spine.
- Lifestyle modifications such as maintaining a healthy weight, exercising regularly, and improving posture may also help to alleviate symptoms of bilateral sciatica 4, 5.