Known as cauda equina syndrome, this is a rare but serious condition and demands urgent intervention in the form of surgical decompression. A drawing of a disc with the nuclear material herniating out through a tear in the annulus. The patient suffering from sciatica will complain of pain radiating down the leg and often into the foot. This typically affects only one leg although bilateral involvement is possible. The patient may complain of numbness in the same distribution.
Weakness is less common but can be significant and can cause a limp.
The history will often include back pain that subsided just before the onset of leg pain. Complete bed rest may provide some relief. The physical exam must include a neurologic assessment to rule out a significant radiculopathy. An understanding of the specific dermatomes and muscles innervated by the individual nerve roots can help localize the level of the herniation. Tension signs such as a positive straight leg-raising test are indicative of nerve compression.