Sciatica is more than just back pain, it’s a nerve issue that can disrupt your sleep, movement, and overall quality of life. While some cases improve with time and conservative care, many can't and that’s when knowing the exact cause of your pain becomes critical.

An MRI is the very best tool doctors and chiropractors have for evaluating sciatica, but just getting the scan isn’t enough. Who reads your MRI matters. If you’ve been diagnosed with a bulging disc or told your MRI is "normal" despite persistent symptoms, a second opinion from a subspecialized neuroradiologist may be the missing piece to identifying the true cause, how serious it is, and the very method to solve the issue without making it worse. 

Understanding Sciatica: It’s a Symptom, Not a Diagnosis

Sciatica refers to pain that radiates along the sciatic nerve, typically from the lower back, through the buttock, and down the leg. It’s often caused by something compressing or irritating the nerve, such as:

• Herniated or bulging discs

• Spinal stenosis (narrowing of the spinal canal)

• Degenerative disc disease

• Facet joint arthritis

• Spondylolisthesis (vertebral slippage)

• Less common causes: tumors, infections, or nerve root anomalies

Why an MRI Is So Important for Sciatica?

An MRI provides detailed images of the soft tissues in your spine, which include your discs, nerves, ligaments, and spinal cord. These soft tissues are not well visualized on X-rays or CT scans. It’s the only way to truly see what’s happening at the nerve level. However, getting accurate insight from an MRI isn’t just about the machine, it’s about the expertise of the radiologist reading it.

The Value of a Neuroradiologist's Second Opinion

A neuroradiologist is a radiologist who has completed extra fellowship training or who has spent their daily practice focused specifically on the brain, spine, and nerves. They bring a deeper level of expertise when interpreting MRIs for conditions like sciatica.

Why is this important? Missed or misinterpreted findings are more common than most patients realize, especially when the MRI is read by a radiologist without spine specialization. A second opinion from a neuroradiologist can:

• Detect subtle disc herniations or extrusions that compress nerve roots

• Recognize nerve root impingement even if it’s only visible on one or two slices of the scan

• Identify lateral recess or foraminal stenosis, which is often underreported

• Pick up annular fissures, small tears in the disc wall that can cause significant pain

• Evaluate post-surgical changes in patients with prior spine surgery, which are complex and often misread

• Spot rare but serious causes like arachnoiditis, nerve sheath tumors, or infections

Commonly Missed MRI Findings in Sciatica Patients

Even well-intentioned, experienced radiologists can miss findings that a subspecialist is trained to look for. Here are a few frequently overlooked issues:

• Far lateral disc herniations that compress exiting nerve roots outside the central spinal canal

• Facet arthropathy causing foraminal narrowing

• Subtle nerve root clumping in early arachnoiditis

• Disc extrusions with sequestered fragments that have migrated up or down the canal

• Spinal cord tethering or anomalies that mimic nerve compression symptoms

• Modic changes (inflammatory changes in vertebral endplates) linked to chronic back pain

These findings can directly change a patient’s treatment plan, from physical therapy to surgical referral or even ruling out surgery if the MRI doesn’t support it.

When Should You Get an MRI and a Second Opinion?

You should strongly consider an MRI if:

• Your sciatica has lasted longer than 6–8 weeks

• You have progressive weakness or numbness

• Conservative treatments haven’t helped

• You’re considering injections or surgery

• You have any red flag symptoms like loss of bladder/bowel control

If you've already had an MRI but still have questions or concerns, or if your symptoms don't align with the original report, getting a second opinion from a neuroradiologist is a smart step.

Take Control of Your Spine Health

Sciatica doesn’t have to be a mystery. With the right imaging and the right expert reading it, you can get answers and peace of mind. At MDView, we connect patients directly with board-certified neuroradiologists who specialize in spine imaging. Our second opinion reports are detailed, easy to understand, and delivered within 72 hours or less, helping you and your doctor move forward with confidence.

Ready to get a second opinion on your MRI?
Let a spine-focused neuroradiologist review your exam and provide the clarity you deserve. Visit https://app.mdview.com to upload your exam and get peace of mind today. Don't have your exam? No problem! MDView can get your exam on your behalf at no charge to you! Just click Have MDView Get My Exam on the homepage of your MDView account today.