What is Sciatica?
The sciatic nerve is composed of the nerve roots from the L4 to S3 vertebral levels that come together to form the largest single nerve in the body. There are two sciatic nerves, one on the left and one on the right side of your body. Sciatica (lumbar radiculopathy) is the condition when there is pain caused compression or irritation of the sciatic nerve. The pain of sciatica begins in the lower back and travels through the buttock and down the leg. The pain can be severe and may be accompanied by numbness or weakness. Causes can include a herniated lumbar disc, lumbar spinal stenosis, or muscle spasms. Conservative treatment will usually relieve symptoms but occasionally surgery is required to provide relief or to prevent permanent nerve damage. Only pain that originates from the sciatic nerve is called sciatica.
Pain that radiates from the lower back on one side, deep into the buttocks and then down thighs and calves. You may have aching, tingling or burning sensations in the affected area. The pain is usually only on one side of the body but may be both. Movement, walking sitting and certain bending or twisting movements may worsen the pain. Symptoms are found along the path of the sciatic nerve. When you are unable to perform your normal daily activities then it is time to see your doctor. In addition, there are sciatica symptoms that may indicate a serious medical condition and require immediate medical attention like infection, a spinal tumor, or cauda equina syndrome. These include symptoms in both legs, bladder or bowel dysfunction, sexual dysfunction, or progressive leg weakness.
Sciatica is a symptom of another medical condition and is not in itself a medical diagnosis. Injury or weakness from aging can cause a herniated disc which can press on the sensory or motor nerves of the spinal cord causing sciatica symptoms. Other factors that can predispose you to sciatica are having a few extra pounds, lack of exercise and weak muscles. Common causes of sciatica also include lumbar spine stenosis, spondylolisthesis, lumbar degenerative disc disease, muscle spasms, and sacroiliac joint dysfunction. Very rarely sciatica may be caused by tumors or blood clots of the lower spine.
Sciatica tends to occur as we age with approximately 25% of the population having sciatica symptoms by age 40. Sitting may predispose you to sciatica and office workers or truck drivers are at a higher risk for symptoms. In addition, people in jobs where the spine is bent forward or arms are frequently raised may have sciatica.
Your doctor will take a complete history which may help determine when or how your sciatica occurred. A physical exam will evaluate you for your source of your pain and discomfort. Your nerve function will be evaluated along with reflexes, muscle strength and skin sensation. He may have you stretch upward, walk on your heels or toes, or lift one leg at a time. Sciatic pain will worsen with these activities.
Imaging tests can help your doctor identify injured areas of spinal bones and muscles:
- X-rays may be used to look for fractures or bone spurs that may be pressing on a nerve but will not show if you have a herniated disc.
- Computed tomography (CT) scan uses the electromagnetic energy of X-rays to provide a detailed look at the bony anatomy spine and tissue around it.
- Myelogram uses dye injected into your spinal fluid and an X-ray to show the location of pressure on the spinal cord or nerve roots.
- Magnetic resonance imaging (MRI) uses powerful magnets and radio waves to create a detailed picture of soft tissue of the spine, spinal cord and spinal nerves.
- Nerve conduction studies look for nerve damage by using electrodes to measure how quickly a nerve impulse is transmitted.
Electromyogram uses needle electrodes to look for muscle damage.
Sciatica will improve with conservative treatment within 4 to 8 weeks. Resting can decrease nerve irritation and allow your back to heal. Ice or heat in the are of discomfort may help you feel better. Over-the-counter medications like ibuprofen (Advil, Motrin) or naproxen (Aleve) are NSAIDs (nonsteroidal anti-inflammatory drugs) that can decrease pain and swelling. If sciatica pain lasts more than 10 days you should talk to your doctor as the side-effects of long term NSAID use rarely include stomach ulcers, circulation problems and heart failure. Muscle relaxants and nerve pain medications can also be used. Stretching and exercises may help improve the symptoms of sciatica. A physical therapist can show you which exercises you should perform to improve posture and flexibility. Steroid injections into the area around the irritated nerve root may decrease inflammation and can last up to a couple of months.
Surgery is generally reserved when the sciatic nerve injury causes progressive bladder or bowel or sexual dysfunction or if conservative treatments do not relief pain. You may require one or a combination of the following procedures.
- Laminectomy or laminotomy– your surgeon uses a microscope to make a small opening in the spinal bone (vertebral arch) to relieve pressure on the nerve roots.
- Discectomy or microdiscectomy– the most common surgery for sciatica involves removing all or a portion of the herniated disc that is pressing on your nerve root. A microdiscectomy uses smaller instruments which are less invasive and can be an outpatient procedure.
- Spinal fusion– two of more of the spinal vertebrae are permanently attached together using bone grafts with plastic or metal screws and rods. This permanently fuses the spine vertebrae in the attached segments. This also requires general anesthesia and a short hospital stay.
The pain of sciatica can be excruciating and debilitating. The neurosurgeons of Norelle Health are highly trained and skilled in the diagnosis, management, and treatment of Sciatica. Our neurosurgeons can provide the optimal treatment. Neurosurgery is considered essential by insurances and should be covered with your plan. As out-of-network providers, we will check your benefits for you and let you know what they are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us (link to contact page) or call our office (link to phone number).