An Overview of Sciatica



sciaticaSciatica is the medical term for pain that radiates down the path of the sciatic nerve. This nerve branches from the lumbar (low back) spine and travels down the hip, buttocks, and each leg. Sciatica usually only affects one body side and is most often the result of a bulging or herniated disc.

However, sciatica can result from a bone spur that comes out in the spinal canal and compresses part of a nerve. When these conditions affect the nerve, there is pain, inflammation, and numbness of the affected lower extremity.

Researchers estimate that 4 million Americans have symptoms of a disc disorder, with a prevalence of 2% in men and 1.5% in women. Sciatica due to disc herniations can require surgery, leading to more than 15,000 operations per year in the U.S. alone.

Symptoms of Sciatica

The pain associated with sciatica is often severe, but most cases resolve within a few weeks with conservative treatment. However, when there is a serious injury or condition causing the sciatica, the patient will continue to have symptoms long after six weeks of treatment. The pain of sciatica:

  • Radiates from the lumbar spine down to the buttock and into the leg
  • Can be perceived into the calf and foot as burning and sharp
  • Described as an as a jolt or electric shock
  • Can worsen with sneezing, coughing, or prolonged sitting
  • Accompanied by numbness, tingling, and muscle weakness of the affected leg and/or foot
  • May only affect one area of the leg and/or foot

Causes of Sciatica

Sciatica occurs when the sciatic nerve is compressed (pinched) from a herniated disc in the spine or from an overgrowth of bone (bone spur). A nerve can also be impinged by a tumor or malignant growth, as well as damage from high levels of circulating glucose (diabetes). The risk factors for sciatica include:herniated disc

  • Age – Age-related changes of the spine are the most common causes of sciatica.
  • Obesity – Excess body weight increases the stress and strain of the spine and contribute to spinal changes that bring on sciatica.
  • Prolonged sitting – Sedentary lifestyle contributes to the condition.
  • Occupation – Jobs that require a person to lift, twist, bend, and use the back for work put the individual at risk for back problems.
  • Diabetes – High levels of glucose in the blood cause poor circulation, which damages nerves.

Diagnosing Sciatica

If a patient has symptoms of sciatica, the doctor will take a medical history, ask numerous questions, and perform a physical examination to assess for strength and reflexes. In addition, the doctor will conduct a series of tests, including:

  • Spine x-ray – To assess for bone spurs and bony abnormalities.
  • Magnetic resonance imaging (MRI) scan – To evaluate the soft tissues and muscles of the back.
  • Computerized tomography/CT myelogram – Used to assess the spinal cord and nerves.

Treatment of Sciatica

Treatment of sciatica depends on the cause of the pain and numbness. Options include:

  • Medications – Commonly prescribed drugs are muscle relaxants, anti-inflammatories, anti-seizure agents, and tricyclic antidepressants.Lumbar_Transforaminal_Epidural(1)

 

  • Physical therapy – The therapist will design a rehabilitation program to help the patient prevent recurrent injuries and teach exercises to correct posture, strengthen muscles, and improve flexibility.

 

  • Epidural steroid injection – The doctor injects a long-acting steroid and possibly an anesthetic into the epidural space near the spinal nerves. This is done to relieve pain by decreasing inflammation.

 

  • MILD – this procedure, call Minimally Invasive Lumbar Decompression, offers patients the ability to undergo an outpatient procedure that decompresses the herniated disc. Patients are able to stay out of the operating room, yet achieve pain relief.

 

Resources

Wheeler AH, Murrey DB. Spinal pain: pathogenesis, evolutionary mechanisms, and management, in Pappagallo M (ed). The neurological basis of pain. New York: McGraw-Hill; 2005:421-52.

Anderssen GBJ. Epidemiologic features of chronic low back pain. Lancet. 1999;354:581-5.

Nachemson Al, Waddell G, Norland AL. Nachemson AL, Jonsson E (eds.). Epidemiology of Neck and Low Back Pain, in. Neck and Back Pain: The scientific evidence of causes, diagnoses, and treatment. Philadelphia: Lippincott Williams & Wilkins; 2000:165-187.