Sciatica is primarily used to describe signs & symptoms of severe leg pain, numbness, tingling or weakness that travels down the lower back region via the sciatic nerve in the backside area of the leg. Sciatica is also referred to as radiculopathy & can occur due to various spinal conditions like herniated discs, degenerative disc disease, spinal stenosis or spondylolisthesis. There are two sciatic nerves, one on each side of the lower body. These are the longest nerves within the human nervous system, running all the way from lower back through thighs & calves to feet. Depending upon how it is defined, approximately 5 – 40 percent people experience sciatica at some point in their lives. It is one of the most commonly experienced conditions in people between the age of 40 – 50 years. Moreover, men are more frequently affected by sciatica than women.
What is Sciatica?
Sciatica is a painful condition & is typically seen advancing along the sciatic nerve. This nerve is located in the lower back region & spreads outwards to hips & buttocks to legs. Sciatica commonly affects any one side of the body. This condition is mostly observed in case of herniated inter-vertebral discs, a bone spur in spine or spinal stenosis which cause the spinal canal to become narrowed & to compress spinal nerves as a result. Severe swelling, pain & numbness in affected leg are the most common symptoms of sciatica. Sciatica can be efficiently treated with non-surgical methods & painkillers if symptoms are mild in nature. However, more severe cases require surgical treatment for alleviating pain & treating symptoms.
Sciatica is mainly caused by harsh irritation in roots of lower back spinal nerves. Other common causes of sciatica are described below.
- Lumbar Spinal Stenosis – This condition results in compression of spinal canal in lower back & causes pressure on the spinal cord.
- Degenerative Disc Disease – It causes gradual disintegration of inter-vertebral discs that act as cushions & stabilizers between vertebrae.
- Spondylolisthesis – This condition causes one vertebra to slip ahead of the one above it & thus contracting the spinal canal as a result.
- Pregnancy & Muscle Spasms in Back or Buttocks – Pregnancy may also create pressure on sciatic nerves of expecting mothers.
Being overweight & obese can also worsen pain in the back & buttocks of patients. Being out of shape, wearing high heels frequently & sleeping on mattresses that are too soft may also make back pain worse.
Following list elaborates common risk factors that increase chances of developing sciatica.
- Age – Degeneration of spine due to advancing age is a natural process. This may result in herniated inter-vertebral discs & bone spurs that put pressure upon spinal nerves & eventually cause sciatica.
- Overweight – Being obese increases risk of developing sciatica as excessive weight stresses the spine & may alter shape of spinal bone & give rise to sciatica.
- Occupational Hazards – Jobs that require twisting the back, carrying heavy loads or driving an automobile for prolonged periods of time often gives rise to sciatica.
- Diabetes – This pancreatic disorder increases risk of general nerve damage.
Following list advocates some common signs & symptoms of sciatica.
- Lower back pain
- Severe leg pain
- Harsh pain in the hip
- Tingling or burning sensation in leg
- Numbness or weakness in leg
- Difficulty in walking
- Constant pain in one side of the buttock
- Intense pain while standing
- Loss of bladder or bowel movement
In some cases, pain from sciatica is mild, infrequent & irritating but is likely to worsen if left untreated. In other cases, pain from sciatica may be severe & disabling. Patients should seek immediate medical advice when they experience any sort of numbness or weakness in lower back that has gradually progressed to back of the upper thighs.
Doctors will initially perform a complete physical examination to check for signs of muscular weakness & reflexes. During physical evaluation, patients may feel pain worsening while walking on toes or heels, while rising from squatting & while lifting leg from a lying position. Doctors may also perform certain imaging diagnostic tests that may be useful for diagnosing sciatic disorder.
- X-Ray Test – Spinal x-rays can help reveal bone spurs (overgrown or abnormal bone) that might be compressing spinal nerves.
- MRI (Magnetic Resonance Imaging) Test – This advanced diagnostic test uses powerful magnetic fields & radio waves to create cross-sectional images of the back. This test reveals clear details of bones as well as soft tissues (herniated inter-vertebral disc, etc).
- CT (Computerized Tomography) Scan – In this imaging test, doctors might need to inject a contrast dye into the spinal canal of patients by using a very fine needle through back before x-ray imaging process is started.
- CT Myelogram – This helps to accentuate the spinal cord & spinal nerves from spine.
- EMG (Electromyography) – This test reads electrical impulses produced by nerves & muscles. This is useful for determining conditions like spinal stenosis in patients who might have developed sciatica.
Not every patient who has sciatica requires medical care. When symptoms are serious or persist for few months though, patients should make an appointment with an experienced spine or neurosurgeon.
- Symptoms – Patients should note down observed symptoms & the time they began.
- Medications – Patients should list down key health status & medical information, including other conditions they have & also names of medicines, vitamins or supplements they are taking.
- Incidents – Patients should note recent injuries or accidents that might have blemished their back.
- Queries – In order to understand the complete treatment procedure for sciatica, patients should be ready to ask doubts & questions to spine surgeons & must answer questions honestly which doctors ask them.
Patients may take a family member or friend along with them for consultation, if possible; someone who can take care of details provided by spine surgeons during the initial consultation.
Patients may wish to discuss some important concerns regarding treatment of sciatica with spine surgeons. During consultation for radiating low back pain, the following list of queries may be helpful.
- What might be the cause of my harsh back pain?
- What is my current health status?
- Can you elaborate result of my diagnostic tests?
- What is sciatica?
- What treatment do you advice is suitable in my case?
- If you are suggesting medications, what are the common side-effects of these medications?
- For how much time will I require to take these medicines?
- Am I a suitable candidate for spinal surgery? Why or why not?
- Are there any lifestyle restrictions I need to follow?
- What self-care measures should I undertake?
- How much time will it take for complete recovery?
- What can I do to prevent back pain from recurring?
In addition to these questions, patients should not hesitate to ask spine surgeons any other doubts that they might be having.
Treatment Options for Sciatica
In certain cases where rest & other home-measures do not relieve the back pain due to severe condition of sciatica, the doctors may advise any of the following suitable treatment plans.
Following medications are most commonly prescribed by spine surgeons for alleviating sciatica pain.
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
- Narcotics (pain killers)
- Muscle relaxants
- Anti-seizure medications
In some cases, steroid drugs are injected into the space around the spinal nerve of patients. Recent researches suggest these injections have a modest effect when irritation is caused by pressure from a ruptured or herniated disc.
As soon as back pain lessens by consuming prescribed medications, the physiotherapist will plan a physical therapy program for patients to prevent further complications. These generally include simple exercises which are aimed at improving posture, strengthening the patient’s back muscles & for restoring flexibility.
Certain cases might require administering corticosteroid injections into affected nerve areas to help lessen pain through suppressing inflammation around the irritated nerve. These are required to be taken every few months as their effects may wear off after some time.
Surgical treatment for sciatica is performed when the compressed nerve causes noticeable weakness & loss of bladder or bowel movement. It is also recommended when pain seems to worsen & advance to outer extremities in lower limbs & does not respond to other treatments like medications or physiotherapy. During surgery, spine surgeons will probably pull off the bone spur which is causing compression or remove the herniated inter-vertebral disc which is pressing against the affected nerve in spinal canal.
This is a small open surgery which uses magnification in cases where sciatica pain is due to lumbar disc herniation. It is the most common surgical intervention for sciatica where only the portion of herniated disc which is pinching the nerve is removed & the rest is left intact. Utilizing the most modern microdiscectomy techniques, spine surgeons are able to minimize the extent of theoperation. This operation involves minimal tissue damage by using standard 1 – 1.5 inch incisions & by focusing tissue dissection on spreading ligaments & muscles instead of cutting them.
This procedure is usually recommended by spine surgeons in cases where sciatica pain is due to lumbar spinal stenosis. A small portion of bone and/or disc material which is pinching the nerve root is removed during this surgical procedure. Lumbar laminectomy surgery is usually offered as an option by spine surgeons when spinal stenosis is causing steep fall in patient’s activity tolerance to unacceptable levels. General health conditions of a patient may also be an important consideration while choosing this surgical intervention. Generally known as an open decompression procedure, lumbar laminectomy is typically performed for pain due to lumbar spinal stenosis. The goal of this procedure is to allow more room for nerve roots. This will eventually result in reducing pain & potentially any weakness or neurological symptoms in leg while restoring the patient’s ability to participate in normal everyday activities.
The disturbing vertebral body can also be removed through an anterior incision so as to decompress the spinal canal. Corpectomy surgery involves removing parts of vertebrae in order to relieve or decompress pressure on spinal nerves and/or the spinal cord. This surgery is most commonly used in cervical procedures, though occasionally in thoracic spine & rarely in lumbar spine.
This procedure involves a surgical incision for removing a small portion of bony area of spine known as the lamina. Lamina is the back part of each vertebra which forms the back wall of the spinal canal. The spinal cord runs through this spinal canal at the center of these vertebrae. When certain conditions of spine compress the spinal cord & cause pain, laminotomy can effectively relieve pressure in spinal canal & on spinal nerves so as to relieve pain.
For most patients, sciatica responds to self-care measures. Self-care treatments that might help in a faster recovery include the following.
- Cold Packs – Initially, patients might get relief from a cold pack placed on the painful region for up to 30 minutes several times a day.
- Hot Packs – After few days, patients may try applying heat to areas that hurt. If patients continue to have pain, they should try alternating cold & warm packs.
- Stretching – Patients should avoid jerking, twisting or bouncing during stretching & try to pull the stretch for approximately 20 seconds.
- Over-the-Counter Medications – Pain relievers such as naproxen sodium (Aleve) & ibuprofen (Motrin IB, Advil, others) are often helpful for sciatica.
Although most patients recover completely from sciatica without any additional treatment, but sometimes sciatica may cause permanent nerve damage. Patients should seek immediate medical attention if they experience the following complications post-treatment.
- Weakness in affected leg
- Loss of feeling in affected leg
- Swelling & pain
Long-term outcomes of sciatica treatment are favorable for a majority of patients with conditions like disc herniation. Patients can minimize risk of further episodes of sciatica by following the given instructions.
- Performing stretching before & after exercise
- Adopting a better posture & lifting techniques at work
- Maintaining a healthy lifestyle
While sleeping, the mattress should be tough enough to support patient’s body while aiding weight of buttocks & shoulders & keeping the spine straight. In case patient’s sleeping mattress is too mushy, they should place a hard board under the mattress. The neck should not be at a steep angle while sleeping.
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