Sciatica, also known as lumbar radiculopathy, 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.
Symptoms of Sciatica
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.
Causes of Sciatica
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
To diagnose the cause of your sciatica, a person may need to have some imaging tests, such as an x-ray or a computed tomography (CT or CAT) scan. If it’s possible a herniated disc or spinal stenosis is causing the sciatica, a doctor may order a magnetic resonance imaging (MRI) test.
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.
If you have questions about spinal stenosis or the minimally invasive spine procedures offered by DISC of Louisiana, please contact us to schedule an evaluation at one of our clinics across the south Louisiana region.
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