What Is Sciatica?
Sciatica is a commonly used term when people are describing back pain with radiation down one or both legs. While the term sciatica back pain is used frequently, the proper term for back pain with radiation to the leg is lumbar radiculopathy. In addition to pain going down one or both legs, sciatica symptoms can also include numbness, tingling or a pins and needles sensation, or weakness in the legs. The pain is not diffuse involving the entire leg, but follows a particular distribution depending on which nerve in the lower back is affected. The most common nerves affected are the L5 and S1 nerves, with symptoms being felt in the buttock and thigh, and down the back (S1) or to the outer aspect of the lower leg (L5).
Sciatica Pain Causes
There are several conditions that can result in the clinical symptoms of sciatica. These can include herniated discs which can cause a pinched nerve in the back resulting in back pain that radiates down the leg. Degenerative disc disease can also result in sciatica symptoms. Other sciatica pain causes include scoliosis, synovial facet cysts, spondylolisthesis, in addition to other less common causes of sciatica pain.
Sciatica Assessment and Diagnosis
The proper assessment of sciatica symptoms begins with a careful history and physical examination. This can be done by your primary care doctor, a non-surgical spine specialist (physiatrist or anesthesiologist trained in pain management), or a spine surgeon. The doctor will ask about the onset of symptoms, how long they have been persistent, what treatments have been tried, and if there is any associated numbness or weakness. The doctor will also perform a neurological examination to check the function of the nerves of the lower back.
Sciatica Pain Treatment
There are both conservative and surgical strategies for how to relieve sciatica pain.
Sciatica treatments usually begin with conservative measures as most sciatica pain can be relieved without the need for surgery.
Sciatica pain treatment is initiated with anti-inflammatories (NSAIDS) and physical therapy. A low-impact regular exercise program (brisk walking, cycling, stationary bike, elliptical machine, etc.)is very important to treat sciatica symptoms as the increased blood flow from regular exercise provides oxygen to the nerves and helps them recover. If a patient smokes, quitting smoking is critical to relieving sciatica symptoms as the nicotine in the cigarette smoke impairs blood flow to the nerves and accelerates degenerative disc disease in the spine.
Patients that are overweight are also recommended to lose weight as the increased stress on the spine from excess weight can increase sciatica symptoms.
Targeted injections such as epidural injections or other spinal injections may also be beneficial. These are performed by non-operative spinal specialists such as physiatrists or anesthesiologists trained in pain management.
If symptoms have been persistent for more than 6-12 weeks despite conservative treatment and there is a precise cause of the sciatica symptoms that has been identified on the xrays and MRI, then surgery may be beneficial.
The exact operation depends on the precise problem and patient specific factors, but common operations for sciatica pain include a microdiscectomy, lumbar decompression, or a lumbar decompression and fusion. These procedures can often be performed minimally invasively.