When to Refer A Patient With Sciatica

If a patient has been suffering from sciatica and he or she develops other ‘red flag’ symptoms, an urgent referral should be made to a specialist.

Lower back pain and sciatica

Lower back pain with or without sciatica is an extremely common problem. Sciatica is the term used to describe pain, numbness and tingling that extends from the lower back to the buttocks, leg and calf. The pain may be present in one leg (unilateral sciatica) or both legs (bilateral sciatica).

Sciatica occurs when the sciatic nerve – the longest nerve in the body – is irritated or compressed. Around 90% of cases of sciatica are caused by a slipped disc. This will press upon the nerve roots in the lumbosacral spine, resulting in sciatic pain.

Treating sciatica

It is unlikely that those will sciatica have a serious underlying medical problem. Most will be diagnosed with simple back pain and offered treatment to manage their symptoms. This will include painkillers, physiotherapy and exercise.

However, medical professionals should monitor patients with sciatica as further problems can develop. For example, if the cauda equina nerves also become compressed, it will lead to a condition called cauda equina syndrome. This is a rare neurological disorder that causes a loss of function and sensation in the lower limbs, pelvic organs and genitalia.

When to refer a patient with sciatica

A patient with sciatica should be referred to a specialist if there is any indication that cauda equina nerve compression has occurred. The warning signs that merit further investigations or even an emergency admission are:-

• Saddle anaesthesia (meaning numbness and tingling between the legs/in the perineum);
• Recent onset of bladder dysfunction;
• Recent onset of faecal incontinence and loss of anal tone;
• Neurological deficient in the lower extremities.

Together these symptoms are called the red flag symptoms of cauda equina syndrome. They are so called because they should indicate nerve compression, alerting medical professionals to the presence of a serious condition.

A patient with the red flag symptoms of cauda equina syndrome should be urgently referred to a specialist. Alternatively if the red flags symptoms are not present but there is progressive neurological deficit, a patient should be referred for neurological or orthopaedic assessment (to be seen within a week).

Failure to refer

If medical professionals fail to notice that a patient with sciatica is also displaying the red flag symptoms of cauda equina syndrome, there will be a delay in diagnosis and treatment. This can result in permanent neurological complications, including paralysis and incontinence.

If you have suffered injury because doctors failed to diagnose your cauda equina syndrome, you could be entitled to claim compensation. Get in touch with us to find out more.

Please call us free on 0800 234 3300, from a mobile click to call 01275 334030 or complete our Free Online Enquiry for a no cost, no obligation opinion.

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