Sciatica, Stenosis, or Something Worse?
April 15, 2026
Pain shooting down your leg. Numbness in your foot. A burning sensation along your lower back that gets worse when you sit. These symptoms send millions of Americans to the internet every year searching for answers, and what they find is a long list of possibilities, ranging from benign muscle tension to something that requires urgent attention.
Most of the time, leg pain and back pain are exactly what they appear to be: a pinched nerve from a herniated disc, or narrowing of the spinal canal that puts pressure on nerve roots. But occasionally the cause is something more serious. Knowing when to push for a deeper look is one of the most valuable things a Los Angeles neurosurgeon can help you with.
Sciatica is not technically a diagnosis. It is a description of symptoms—specifically, pain, tingling, or numbness that travels along the sciatic nerve from the lower back down through the buttock and into the leg, sometimes reaching the foot. It is extremely common, affecting an estimated 10 to 40 percent of people at some point in their lives.
The most frequent cause is a herniated disc in the lumbar spine, which is when a disc’s inner material pushes through its outer layer and presses on a nearby nerve root. The second most common cause is lumbar spinal stenosis, where the spinal canal narrows over time due to degenerative changes, putting pressure on the nerves that run through it.
Both conditions are very treatable, and the large majority of patients improve with conservative care: physical therapy, anti-inflammatory medications, targeted injections, and activity modification. Surgery becomes a conversation when conservative care fails, when symptoms are severe, or when there is progressive neurological change.
Stenosis tends to show up differently than disc herniation and learning to distinguish the two helps patients have better conversations with their doctors. The classic picture of lumbar stenosis is neurogenic claudication: pain, heaviness, or cramping in the legs that develops when walking or standing for extended periods and relieves with sitting or bending forward.
This “shopping cart sign”—the tendency to feel better leaning on a cart while walking—is one of the most recognizable patterns in spine medicine. Stenosis typically develops gradually over years, and it is more common in patients over 50. Many patients in the Los Angeles area who are active well into their 60s and 70s find that stenosis begins limiting activities they have enjoyed for decades.
It is a quality-of-life diagnosis. The urgency of treatment depends on how much it is interfering with daily function—and whether conservative measures have given adequate relief.
Here is where things get complicated. Disc herniations and stenosis can produce nearly identical symptoms. Other conditions—hip arthritis, peripheral neuropathy, vascular claudication—can mimic spinal conditions closely enough to fool even experienced doctors without proper imaging and evaluation.
And then there is the rarer category: spinal tumors, cysts, infections, and inflammatory conditions that can produce back and leg pain indistinguishable from the common diagnoses—at least at first. A patient treated for months for sciatica with physical therapy and injections, who is not improving, deserves a second look. The failure to respond to standard treatment is one of the most important clinical signals that something else may be going on.
Warning signs that should prompt a more thorough evaluation include:
None of these symptoms automatically mean something serious is happening. But they are flags that tell a neurosurgeon to look more carefully.
Primary care doctors and physiatrists are excellent first-line resources for spine-related symptoms. A patient who has been symptomatic for months without improvement, has confusing imaging findings, or simply has not gotten a clear answer may benefit from a neurosurgeon’s evaluation.
Neurosurgeons interpret spine imaging differently than general surgeons. We are looking for subtle nerve compression patterns, early signal changes in the spinal cord on MRI, or unusual tumor characteristics that a radiologist may note but underweigh in their report. We are also trained to correlate imaging findings with your physical examination. A finding on an MRI is only meaningful in the context of what you are actually experiencing.
Patients in West Los Angeles, Santa Monica, Brentwood, Culver City, and surrounding neighborhoods do not need to travel to a university hospital to get this level of evaluation. Subspecialty neurosurgical care is available locally.
When a patient comes to our office in Marina Del Rey or Tarzana with back and leg pain, the evaluation is thorough. We review all prior imaging, perform a detailed neurological examination, and take time to understand how your symptoms are affecting your daily life. We explain what we see, what we think it means, and what the reasonable options are as well as the option to watch and wait.
Not every spine evaluation ends with a recommendation for surgery. In fact, the majority do not. But having clarity about what is causing your symptoms is worth every bit of the effort it takes to make
that appointment.
Concerned about your back or leg symptoms? Request a diagnostic consultation with Dr. Luke Macyszyn today.
