What Is Sciatica?
Sciatica explained by San Antonio, Austin, Houston, Dallas Texas top pain doctors
Sciatica refers to pain radiating along the course of the sciatic nerve, the longest and largest nerve in the body. It is a consequence of inflammation of the nerve. The sciatic nerve originates in the lower back, goes through the buttocks, and runs down the back of each leg. It ends just above the rear aspect of the knee.
Symptoms of sciatica may include leg pain, weakness, numbness, or tingling. Leg pain may be described as burning, shooting, throbbing, or cramping. The pain can vary from a mild ache to severely excruciating. Sciatica may be aggravated with sneezing, coughing, or sitting too long. Lastly, the pain is typically isolated to one leg.
Causes Of Sciatica
In 90% of cases, sciatica results from a herniated or bulging disc in the back. The diseased disc exerts pressure on the root of the sciatic nerve, which causes pain and other symptoms. The diagnosis can be arrived at through a combination of a medical history survey, physical examination, and studies such as X-ray, magnetic resonance imaging (MRI), computed tomography (CT), nerve conduction, or myelogram (X-ray record of the spinal cord).
Other causes of sciatica include bone spurs, piriformis syndrome, spondylolisthesis, and spinal stenosis. Bone spurs are projections that form along the edges of a backbone (vertebra). Piriformis syndrome occurs when the piriformis muscle, located in the buttocks, spasms and compresses the sciatic nerve. Spondylolisthesis is a back condition in which a vertebra slips forward over the vertebra beneath it. Spinal stenosis refers to a narrowing of the spinal cavity. All of these causes culminate in inflammation or irritation of the sciatic nerve, which leads to leg pain and other symptoms.
Treatments For Sciatica
Treatments for sciatica vary widely, both in their scope and level of effectiveness. The mainstay of treatments for this disease is non-surgical. The goal of treatment is to decrease inflammation and increase mobility. Non-steroidal anti-inflammatory drugs (NSAIDs) are pillars of treatment. These include medications such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol). Other treatments include muscle relaxants, narcotics, antidepressants, and anti-seizure medications.
NSAIDs are usually combined with physical therapy. Physical therapy is usually commenced with a qualified physical therapist and consists of exercises for the back, abdomen, and legs. The goal of physical therapy is to strengthen muscles and increase flexibility.
For patients with severe pain from sciatica, epidural steroid injections (ESI) are a consideration. This procedure consists of injecting corticosteroids into the area near the inflamed sciatic nerve root. Corticosteroids are potent suppressors of inflammation. The procedure is limited to no more than three times per year to decrease the chance of serious side effects.
Surgery is an option for patients with progressing symptoms, severe pain, or sinister symptoms such as significant muscle weakness and sudden bowel or bladder dysfunction/incontinence. Surgical treatment options include microdiscectomy and laminectomy. A microdiscectomy is minimally invasive spine surgery done with a microscope to remove portions of a disc. It is particularly efficacious if the etiology of sciatica is a herniated or protruding disc. The procedure is also known as a microdecompression.
A laminectomy involves removing the lamina, the back part of the vertebra that covers the spinal canal. The procedure is especially helpful in patients with symptoms caused by spinal stenosis, as it relieves compression of the sciatic nerve. It is also known as an open decompression. The majority of patients opting for surgical techniques report a decline in the pain of sciatica.
Alternative therapies are also available for patients experiencing sciatica. Patients with an aversion to medication or surgery or those excluded by a pre-existing medical condition are great candidates. The options include yoga, acupuncture, massage, biofeedback, and spinal manipulation by a chiropractor.
Sciatica should be considered a symptom and not a condition. It is caused by inflammation or irritation of the sciatic nerve, the largest and longest nerve in the human body. The manifestations of this symptom vary from mild to excruciating pain capable of incapacitating those diagnosed. The etiologies of this symptom are diverse and include herniated discs, bone spurs, piriformis syndrome, spondylolisthesis, and spinal stenosis.
Most patients respond to conservative treatment including medication and physical therapy. Patients not responding to conservative treatment, or with progressing symptoms, may be candidates for epidural steroid injections or surgery. There are also alternative therapies for those patients who prefer a holistic approach to their bout with sciatica.
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- Dreiser RL, Le Parc JM, Velicitat P, Lleu PL. Oral meloxicam is effective in acute sciatica: two randomised, double-blind trials versus placebo or diclofenac. Inflamm Res. 2001;50:S17-23.
- Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. 2007;334:1313-7.
- Selim AJ, Ren XS, Fincke G, Deyo RA, Rogers W, Miller D, et al: The importance of radiating leg pain in assessing health outcomes among patients with low back pain. Results from the Veterans Health Study. 1998; 23:470–474.
- Tubach F, Beaute J, Leclerc A. Natural history and prognostic indicators of sciatica. J Clin Epidemiol. 2004;57:174-9.
- Vroomen PCAJ, Krom MCTFM de, Slofstra PD, Knottnerus JA. Conservative treatment of sciatica: a systematic review. J Spinal Dis. 2000;13:463-9.
- Vroomen PC, de Krom MC, Knottnerus JA: Predicting the outcome of sciatica at short-term follow-up. British Journal of General Practice. 2002;52:119–123.
- Vogt MT, Kwoh CK, Cope DK, Osial TA, Culyba M, Starz TW. Analgesic usage for low back pain: impact on health care costs and service use. 2005;30:1075-81.
- Weinstein JN, Lurie JD, Olson PR, Bronner KK, Fisher ES. United States’ trends and regional variations in lumbar spine surgery: 1992-2003. 2006;31:2707-14.