Sciatica is pain that travels along the sciatic nerve, branching from the lower back through the hips and buttocks and down each leg. It is typically a symptom of an underlying problem, such as a herniated disc or spinal stenosis, which causes compression or irritation of the nerve roots. While most sciatica resolves with home care, a hospital visit is reserved for severe, debilitating pain or when specific neurological symptoms indicate an emergency.
Identifying Sciatica Warning Signs
Severe sciatica pain, especially when accompanied by neurological changes, warrants an immediate visit to the emergency department. These “Red Flags” suggest a potentially serious condition requiring urgent intervention. The most serious red flag is the loss of bladder or bowel control, which can signal Cauda Equina Syndrome.
Cauda Equina Syndrome is a surgical emergency caused by compression of the nerve bundle at the lower end of the spinal cord. Other indicators include severe numbness or loss of sensation in the “saddle area” (groin, buttocks, and inner thighs). Sudden and progressive weakness in one or both legs, such as “foot drop,” also requires immediate medical attention. Sciatica following significant trauma, or accompanied by fever and unexplained weight loss, needs prompt evaluation to rule out infection, fracture, or other serious pathology.
Hospital Assessment and Diagnostic Testing
Upon arrival, the medical team performs a focused assessment to determine the severity and cause of the nerve compression. This begins with a physical examination, checking reflexes, muscle strength, and sensory function in the lower extremities. Doctors may perform the Straight Leg Raise test, which reproduces radiating pain when the leg is raised, indicating nerve root irritation.
Diagnostic imaging is not routine for uncomplicated acute sciatica, but it is ordered immediately if red flags are present or if pain is severe and unmanageable. An X-ray may be taken to rule out fracture or bony abnormalities. If a severe neurological deficit or Cauda Equina Syndrome is suspected, an immediate Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scan is performed. The MRI is valuable because it provides detailed images of soft tissues, such as herniated discs and compressed nerve roots.
Acute Pain Management Protocols
The goal of hospital care for acute sciatica is the immediate reduction of inflammation and pain. Pain control often begins with intravenous (IV) medications because they act faster and are more potent than oral options. This protocol typically involves IV non-steroidal anti-inflammatory drugs (NSAIDs) to target inflammation surrounding the sciatic nerve root.
Muscle relaxers may be administered to relieve painful muscle spasms. For patients experiencing excruciating, refractory pain, a short course of IV corticosteroids may be given to reduce nerve root swelling. In the most severe cases, controlled doses of opioids may be used briefly to manage intense pain, but this is done cautiously due to dependence risks. The medical team may also consult a physical therapist for initial guidance on safe movement and positioning before discharge.
Advanced Procedures and Treatment Planning
If pain remains poorly controlled despite initial medication, the hospital staff plans for more targeted interventions. A consultation with a pain management specialist may be requested to schedule an epidural steroid injection (ESI). This procedure involves injecting a potent anti-inflammatory steroid directly into the epidural space near the irritated nerve root for longer-lasting relief.
Surgical consultation is required immediately if imaging confirms Cauda Equina Syndrome or if severe, progressive neurological deficits persist despite conservative measures. Common surgical procedures include a microdiscectomy, which removes the portion of a herniated disc pressing on the nerve. A laminectomy may be performed if compression is due to spinal stenosis, removing bone to create more space. Upon discharge, the patient receives prescriptions for oral pain medication, a follow-up plan with a physician or specialist, and a referral to outpatient physical therapy.