Sciatica is a type of pain that affects the sciatic nerve, which extends from the lower back down the posterior region of each leg. Also called sciatic neuralgia or lumbosacral radicular syndrome (LSRS), sciatica is often diagnosed along with a debilitating spinal disorder. Sciatica occurs in around 1% of the population.
This condition usually only affects one side of the body, and the pain will extend from the lower back all the way down the back of the thigh into the leg. Depending on which area of the sciatic nerve is injured, the pain can also go to the toes and/or foot. For some people, sciatic pain is debilitating, but for others, it is infrequent and irritating.
What are the symptoms of sciatica?
- Pain in the back of the leg or buttocks that is worse with sitting
- Weakness, numbness, and/or difficulty moving the foot or leg
- Tingling or burning down the back of the leg
- A constant pain on one side of the buttocks
- A shooting pain that makes standing up difficult
What causes sciatica?
- Herniated disc – The most common cause of sciatica is a herniated disc of the lumbar spine, which compresses on a nerve root.
- Lumbar spinal stenosis – This pain is the result of radicular discomfort due to narrowing of the spinal canal in the low back.
- Sondylolisthesis – A condition where one vertebrae slips over another one and presses on a nerve root.
- Degenerative disc disease – This is a break down of the cushions between the vertebrae.
- Other – In addition, sciatica is caused by a tumor, poly-radiculoneuropathy, and/or diabetic neuritis.
What are the risk factors for sciatica?
The risk factors for sciatica include degenerative spinal arthritis, slipped disc, lumbar disc disease, and injury/trauma of the lumbar spine.
What are the conservative treatments for sciatica?
- Physical therapy – This involves heat/ice therapy, ultrasound, exercises, and TENS unit application.
- Chiropractic manipulations – These are done to adjust the spine to alleviate pain.
- Spinal Decompression Therapy – involves intermittent computerized traction. Over 80% effective.
- Acupuncture – This involves the placement of small needles into the skin to stimulate the release of endorphins.
- Biofeedback – This treatment teaches the patient to become aware of body processes, such as heart rate, temperature regulation, and muscle tension.
- NSAIDs – Non-steroidal anti-inflammatory drugs, such as ibuprofen and naproxen, are used to reduce inflammation and pain.
- Anti-convulsants – These are membrane-stabilizing drugs to calm down hyperexcited nerves.
- Anti-depressants – These are used for neuropathic pain to relieve irritated nerves.
- Steroids – A high-dose Medrol dose pack is used to relieve inflammation associated with disc protrusion or spondylosis.
What procedures can be done to treat sciatica?
- Epidural steroid injections – This involves injection of a corticosteroid under x-ray guidance into the epidural space of the lower back, which is the area around the spinal cord. The steroid decreases the swelling to reduce nerve root irritation.
- Adhesiolysis – The Racz procedure involves lysis of adhesions to dissolve scar tissue in the epidural space.
- Spinal decompression – If something is pressing on the spinal cord, the doctor can remove a part of the disc (discectomy), remove part of the spinal bone (laminectomy), or remove bone and disc (foraminotomy).
Thankfully, sciatica surgery can be avoided over 95% of the time with treatment by top Chicago pain doctors.