Sciatica & MRI

Sciatica

need to make a few comments on the diagnosis of “sciatica” (pronounced sigh, at, ick, a).  Sciatica is a rare condition, but that diagnosis is extremely common and made by many, if not most physicians any time a person presents with any pain in leg, even only in the buttock!  Sciatica is a nerve compression of one of the nerve roots exiting the lowermost spine and joining up in the lower buttock to form the sciatic nerve.  True nerve root compression is extremely rare, and I have only seen true sciatic maybe 5 times in 40 years, but I have seen that diagnosis 5 thousand times!  There are many things that can cause pain in the leg, and it does not have to be a pinched nerve.  Folks having a heart attack often have pain in the left shoulder, yet there is no nerve connecting those areas. A simple clinical exam can rule out or rule in true nerve root compression.

MRI

The American College of Physicians and the American College of Pain Management in their research published in 2007 and again in 2011 said that the MRI provides no useful information and is likely to lead to harms (https://doi.org/10.7326/0003-4819-154-3-201102010-00008),  Why would someone order a test like that?  Why would anyone want a test like that?  The simple answer to both these questions – they don’t know this.