Sciatica


If you ask a person with sciatica to describe the pain that they feel the answer can range from a mild numbing, burning or tingling sensation to an excruciating pain that severely affects their quality of life. This complex pain syndrome, felt usually on one side of the body, is caused by the compression and inflammation of one of the two sciatic nerves. The nerves are formed by a collection of nerve roots exiting from the vertebral foramen at L4, L5, S1, S2, and S3 on each side of the lumbosacral spine. They are the longest and widest nerves in the body, and serve as an extension of the spinal cord. Each nerve has two branches, the articular branch that controls hip movement and the muscular branch that controls leg and foot movement. The nerves travel through the pelvic girdle and buttocks and continue down the back of the leg to the foot.

Q: What is the cause of sciatica?
A: There are a large number of neurological and musculoskeletal issues that can cause sciatica. A herniated (bulging) vertebral disc in the lower lumbosacral region causing compression of a sciatic nerve root is most often the cause of sciatica. The condition can also be caused by:

  • Narrowing (stenosis) of the lumbar spine
  • Spondylolisthesis – the slippage of one vertebra over an adjacent vertebra resulting in severe leg pain that is aggravated by walking, sitting or standing
  • Spondylitis – infection or inflammation of the spinal joints, osteomyelitis (infection in the bones of the spine), or sacroiliitis (inflammation in the sacroiliac joints)
  • Degenerative disc disease
  • Pirformis syndrome – inflammation of the sciatic nerve due to irritation from the pirformis muscle
  • Spinal irregularities – lordosis, osteoporosis in the low back, spinal tumors
  • Anatomical irregularities – non-symmetric lower limb growth
  • Excessive weight/obesity
  • Physical trauma – injury to the pelvis, buttocks or thigh due to falls, accidents, etc.
  • Improper lifting technique
  • Lack of exercise/poor muscle tone
  • Poor posture

Q: How is sciatic nerve damage diagnosed?
A: It is estimated that 5 to 15 percent of patients with low back pain have sciatica. The first indication that an individual is experiencing sciatic nerve pain as opposed to other forms of low back pain is the referral of the pain (sciatic radiculitis) into the buttock, thigh, knee, calf and foot. Sciatic pain may worsen when standing, walking, twisting, sitting, coughing, or sneezing.

Given the large number of possible causes for sciatica, an accurate and timely diagnosis of the condition by a back and neck specialist is critical to effective treatment. The specialist’s diagnosis includes a thorough medical history, physical examination and evaluation supported by one of more of the following diagnostic techniques:

  • Standard x-ray – with or without discography or a myelogram
  • Computer-aided radiography – CT scan or magnetic resonance imaging (MRI)
  • Thermography, sonography or a bone scan
  • Electromyography (EMG), nerve conduction studies, and/or evoked potential (EP) studies

Q: What are the treatment alternatives for sciatic nerve pain?
A: The success of any sciatica treatment depends on determining the exact cause of the problem. As is the case with other spinal neuropathy, sciatic nerve pain can be treated conservatively (non-surgically) or aggressively (surgery). Most spine specialists prefer that the patient undergo conservative treatment for a specific period of time. If, at the end of the period, the patient has not experienced a significant improvement, surgery is considered. Experience has shown that sciatic pain can respond very well to non-surgical treatment, provided it is diagnosed early.

Conservative treatments for sciatica are intended to relieve pain symptoms, i.e., make the patient more comfortable with his or her pain. Abatement of the pain, should it occur, will most likely occur gradually over a period of several weeks or longer. The non-surgical treatment altenatives (tried singly or in combination) include:

  • Bed rest
  • Application of hot and cold compresses
  • Physical therapy, yoga, physician-directed exercises, low-impact exercise (aerobics, walking, swimming, stationary bicycle)
  • Muscle relaxants, NSAIDs (non-steroidal anti-inflammatory medications such as aspirin, ibuprofen, etc.), anti-depressants
  • Spinal decompression therapy
  • Cortisone injections, epidural steroid injections
  • Hydrotherapy
  • Massage, acupressure, etc.
  • Glucosamine, herbal treatment, bio-feedback (to change your reaction to the pain)

Surgery is generally regarded as an option of last resort for the treatment of sciatica. The goal of the surgery is to remove the cause of sciatic pain. Depending on the severity of the pain, extent of sciatic-related disability, and various other patient characteristics, the surgeon may elect to perform (1) traditional open discectomy or foraminotomy surgery or (2) a minimally invasive (endoscopic) discectomy or foraminotomy surgery.

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