Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from the lower portion of the spinal column through the hips and buttocks and down each leg. Depending on how it is defined, sciatica impacts 2% to 40% of people, most commonly between the ages of 40 to 50, and affects men more than women.
Sciatica is often characterized by one or more of the following:
- Constant pain in only one side of the buttock or leg (rarely can occur in both legs)
- Pain that is worse when in a sitting position
- Inflammation, burning or tingling down the leg (vs. a dull ache)
- Weakness, numbness down the back, outside or front of the leg
- Difficulty moving the leg or foot
- A sharp pain that may make it difficult to stand up or walk
- Lower back pain is sometimes present
For some people, the pain from sciatica can be severe and debilitating. For others, it might be infrequent and irritating, but it has the potential to get worse. People who continue to have severe sciatica after six weeks of conservative treatment might be helped by surgery.
Sciatica is caused by irritation of the nerve root(s) of the lower lumbar and lumbosacral spine. About 90% of the time sciatica is caused by a spinal disc herniation pressing on one of the lumbar or sacral nerve roots.
Additional common causes of sciatica include:
- Lumbar spinal stenosis (narrowing of the spinal canal in the lower back)
- Degenerative disc disease (breakdown of the discs that act as cushions between the vertebrae)
- Spondylolisthesis (a condition in which one vertebra slips forward over another one)
- Piriformis syndrome (a condition in which a buttock muscle spasms or irritates the nearby sciatic nerve causing pain)
- Pelvic tumors
- Compression by a baby’s head during pregnancy
NON-SURGICAL TREATMENT OPTIONS
Typically, the initial treatment is with nonsteroidal anti-inflammatory drugs (NSAIDS) and short-term pain medications along with the recommendation to continue normal activities when possible. Often all that is required is time; in 90% of the cases, the problem resolves in less than six weeks.
Other conservative treatments include medical management with gabapentin/lyrica and physical therapy. Epidural steroid injections are usually done prior to surgical intervention.
For people who continue to have severe sciatica after six weeks of treatment, surgery may be considered to relieve the pressure on the nerve. Depending upon the cause of the sciatica, treatments vary. A herniated disc is most often treated with a laminectomy or discectomy. Stenosis/Degenerative Disc Disease may be treated with a Minimally Invasive Laminectomy. Spondylolisthesis may be treated with a Minimally Invasive Posterior Lumbar Interbody Fusion.
When surgery is required, minimally invasive spinal procedures are preferred due to the smaller incision required to access the problem area. Smaller incisions and less tissue damage means:
- Less pain
- Faster, non-complicated healing
- Less blood loss
- Quicker rehabilitation
Most minimally invasive spinal procedures used to treat sciatica are performed as an outpatient procedure, have a quick recovery and a very good long-term prognosis. With only a short course of pain medication after the surgery and a short course of physical therapy, patients can usually resume normal activities in 2-3 weeks.
Glossary of Terms:
Degenerative Disc Disease – breakdown of the discs that act as cushions between the vertebrae
Discectomy – removal of a disc
Herniation – abnormal bulging
Interbody Fusion – joining two or more vertebrae together
Laminectomy – a procedure whereby a surgeon removes the lamina in order to relieve pressure on the spinal cord
Lumbar – the five vertebrae that compose the lower spine
Neuralgia – intense, typically intermittent pain along the course of a nerve
Neuritis – inflammation of a peripheral nerve, usually causing pain and loss of function
NSAID – non-steroidal anti-inflammatory drug
Sacral – referring to the sacrum, that segment of the spine below the lumbar spine
Sciatic – nerve that branches from the lower portion of the spinal cord to the hips and buttocks and down each leg
Spondylolisthesis – a condition in which one vertebra slips forward over another one
Stenosis – is the narrowing of spaces in the spine (backbone) which causes pressure on the spinal cord and nerves.
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