Sciatica (Lumbar Radiculopathy)
West Palm Beach, FL
Restore Function Without Surgery
Biologics Guided by Evidence
Board-Certified Physician
Restore Function Without Surgery
Biologics Guided by Evidence
Board-Certified Physician
Sciatica (Lumbar Radiculopathy)
West Palm Beach, FL
Restore Function Without Surgery
Biologics Guided by Evidence
Board-Certified Physician
Sciatica Is a Symptom, Not a Diagnosis. Finding the Source Changes Everything.
Sciatica — the shooting pain, numbness, or weakness that travels from the lower back down the leg — is one of the most common and most mismanaged pain complaints in medicine. It is not a diagnosis in itself. It is a symptom of nerve root irritation, and the cause determines the treatment. At Palm Beach Regenerative, Dr. Ghattas identifies the exact nerve root involved and the structure responsible — then treats both the nerve environment and the underlying FSU contributors driving the compression.
Results vary. Not all patients are candidates. Dr. Ghattas will discuss realistic expectations for your specific condition.
UNDERSTANDING THE CONDITION
What is sciatica — and what causes it?
The sciatic nerve is the longest and widest nerve in the body, formed by the convergence of nerve roots from L4, L5, and S1. When any of these roots are compressed or inflamed in the lumbar spine, pain, numbness, tingling, or weakness can travel along the nerve’s distribution—into the buttock, down the back of the thigh, and into the calf or foot. The pattern of symptoms often helps identify which nerve root is involved.
True lumbar radiculopathy must be distinguished from referred pain (which does not follow a dermatomal pattern) and from piriformis syndrome (where the sciatic nerve is compressed in the buttock rather than the spine). This distinction is critical because it determines where treatment should be directed.
Sciatica Nerve Root Reference
L3-L4
Pain distribution: Inner thigh, knee, anterior shin
Treatment consideration:
Common cause: L3–L4 disc herniation or foraminal stenosis
Weakness / reflex change: Knee extension weakness; reduced knee reflex
L4–L5
Pain distribution: Outer shin, top of foot, big toe
Treatment consideration:
Common cause: L4–L5 disc herniation (most common level)
Weakness / reflex change: Great toe / foot dorsiflexion weakness
L5–S1
Pain distribution: Back of thigh, calf, outer foot
Treatment consideration:
Common cause: L5–S1 disc herniation or SI joint
Weakness / reflex change: Ankle plantarflexion weakness; reduced ankle reflex
| Root | Pain Distribution | Common Cause | Weakness/Reflex Change |
|---|---|---|---|
| L3-L4 | Inner thigh; knee; anterior shin | L3-L4 disc herniation or foraminal stenosis | Knee extension weakness; reduced knee reflex |
| L4-L5 | Outer shin; top of foot; big toe | L4-L5 disc herniation (most common level) | Great toe / foot dorsiflexion weakness |
| L5-S1 | Back of thigh; calf; outer foot | L5-S1 disc herniation or SI joint involvement | Ankle plantarflexion weakness; reduced ankle reflex |
Important: Severe or progressive neurological deficit—such as significant leg weakness, foot drop, or any change in bowel or bladder function—requires urgent medical evaluation and is not appropriate for orthobiologic treatment without surgical clearance first.
Causes
What causes lumbar nerve root compression?
1) Disc herniation
The most common cause. A herniated nucleus pulposus contacts the nerve root directly, causing chemical irritation and mechanical compression. L4–L5 and L5–S1 are the most frequently affected levels.
2) Foraminal stenosis
Narrowing of the opening through which the nerve root exits the spine—caused by disc height loss, bone spur formation, or facet joint hypertrophy. Often produces symptoms with standing and walking rather than sitting.
3)Central canal stenosis
Narrowing of the spinal canal itself, compressing multiple nerve roots. Causes neurogenic claudication—bilateral leg pain and heaviness with walking, relieved by sitting or flexing forward.
4) Spondylolisthesis
Vertebral slippage that narrows the foramen and stretches the exiting nerve root. Grade I–II spondylolisthesis may be amenable to FSU stabilization treatment.
5) Piriformis syndrome
The sciatic nerve is compressed by the piriformis muscle in the buttock rather than in the spine. Presents similarly to lumbar radiculopathy, but MRI is normal. Treated differently—image-guided perineural hydrodissection at the piriformis.
THE PBRSS APPROACH
Treating sciatica through the FSU
Our approach to sciatica addresses both the nerve root and the FSU structures responsible for the
compression. Suppressing the nerve's pain signal alone — the approach of traditional corticosteroid
epidurals — rarely provides lasting relief if the disc, facet, or instability driving the compression is left
untreated.
1) Epidural PRP (transforaminal or interlaminar)
Image-guided delivery of platelet-rich plasma into the epidural space around the affected nerve root. Unlike corticosteroid epidurals, PRP aims to support your body’s natural response to nerve root inflammation rather than simply suppressing it. Performed under fluoroscopic guidance with contrast confirmation of accurate placement.
2) Perineural hydrodissection
Image-guided injection of fluid along the nerve root to release adhesions and reduce mechanical tethering of the nerve—particularly useful in post-surgical sciatica or chronic radiculopathy with fibrosis around the nerve.
3)FSU treatment of the driving structure
Treating the nerve environment without addressing what is causing the compression is incomplete. Dr. Ghattas simultaneously targets the responsible FSU structure: facet joint PRP for foraminal stenosis driven by facet hypertrophy, ligament prolotherapy for instability-driven nerve irritation, or disc-adjacent treatment where appropriate.
4) Piriformis release (for piriformis syndrome)
When the cause is identified as piriformis syndrome rather than spinal stenosis, image-guided perineural injection and hydrodissection around the sciatic nerve at the piriformis level addresses the source directly—without any lumbar procedure.
AM I A CANDIDATE?
Candidacy for sciatica treatment
May be appropriate if you:
- Have confirmed lumbar nerve root compression on MRI
- Have radicular symptoms (pain, numbness, tingling) in a dermatomal pattern
- Have not responded to physical therapy, NSAIDs, or conservative care
- Want to explore alternatives to corticosteroid epidurals or surgery
- Have no severe or progressive neurological deficit
May not be appropriate if you:
- Have severe, progressive, or acute neurological deficit
- Have cauda equina syndrome (bowel/bladder changes) — urgent surgical evaluation required
- Have not yet had current lumbar MRI reviewed
- Have a cause of sciatica (tumor, infection, fracture) requiring direct intervention
- Are in an acute pain crisis — this is not an emergency treatment
Ready to understand the real source of your back pain?
Dr. Ghattas will review your imaging and assess your lumbar spine as a complete system, then discuss which structures are contributing and whether orthobiologic treatment is appropriate for your specific case.
FDA/FTC Compliance Note: Like all medical procedures, orthobiologic treatments have potential risks and benefits. Results vary by individual. Not all patients are candidates. The majority of spine procedures use platelet-rich plasma (PRP) rather than bone marrow concentrate. These treatments do not regenerate or rebuild damaged discs or spinal structures. Dr. Ghattas will discuss your specific situation, realistic expectations, and all options—including when surgical referral is more appropriate. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment.
→ This condition is treated as part of the Lumbar Functional Spinal Unit (FSU). Dr. Ghattas evaluates
every contributing structure — not just the affected segment. See the FSU overview page to understand the
full treatment philosophy.
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