Sciatica is a relatively common form of back pain that radiates along the sciatic nerve. The sciatic nerve is the largest single nerve in the human body; it runs from each side of the lower spine through deep in the buttock and back of the thigh, and all the way down to the foot, connecting the spinal cord with the leg and foot muscles.
The pain can be severe for some, for others it is infrequent and irritating, but has the potential to get worse. Sciatica usually affects only one side of the lower body, often radiating from the lower back down through the buttock and down the leg. The leg pain is often worse than the pain in the back. Depending on which part of the sciatic nerve is affected, the pain may also extend into the foot or toes.
The most common causes of sciatica are usually pressure on the sciatic nerve from a herniated disc (also referred to as a ruptured disc, pinched nerve, slipped disk, etc.) or spinal stenosis. The problem is often diagnosed as a “radiculopathy”, meaning that a disc has protruded from its normal position in the vertebral column and is putting pressure on the radicular nerve (nerve root).
Symptoms
Any of the following sensations may occur with sciatica:
- Pain in the buttock or leg that is worse when sitting
- Burning or tingling down the leg
- Weakness, numbness or difficulty moving the leg or foot
- A constant pain on one side of the buttocks
- A shooting pain that makes it difficult to stand up
While sciatica can be very painful, it is rare that permanent nerve damage (tissue damage) will result. Most of the pain results from inflammation and will get better within two weeks to a few months. Also, because the spinal cord is not present in the lower (lumbar) spine, a herniated disc in this area of the anatomy does not present a danger of paralysis.
Most cases of sciatica will get better with time and conservative care. However, some sciatica symptoms may indicate a potentially serious injury to the nerve:
- If weakness is present, the nerve may be damaged and it is important to seek attention from a health care professional. If the nerve is compressed and the pain and symptoms are severe, surgery may be warranted.
- If there is bowel or bladder incontinence (inability to control the bowel or bladder) and/or progressive weakness or loss of sensation in the legs, the condition may be serious and immediate medical attention should be sought.
Diagnosis
Sciatica is a symptom and not a diagnosis. The term literally means that a patient has pain down the leg from compression on the sciatic nerve. The diagnosis is what is causing the compression (such as a disc herniation or spinal stenosis). The vast majority of sciatic episodes heal themselves within 6 to 12 weeks. If it doesn’t get better on its own, various treatment options can be considered.
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Conservative care
There are a number of conservative treatment options available to help alleviate the pain and discomfort of sciatic pain.
- Heat/ice
For acute sciatica pain, heat and ice packs are quite often the first step to try for relief. Usually ice or heat is applied for approximately 20 minutes, and repeated every two hours. Most people use ice first, but some people find more relief with heat. The two may be alternated. - Medications
Over-the-counter or prescription medications may also be helpful in relieving sciatica pain. Non-steroidal anti- inflammatory drugs (NSAIDs) or oral steroids can be used to reduce the inflammation and pain. - Epidural steroid injections
If the pain is severe, an epidural injection can be performed to reduce the inflammation. An epidural is different from oral medications because it injects steroids directly to the painful area around the sciatic nerve to help decrease the inflammation that may be causing the pain. While the effects tend to be temporary (providing pain relief for as little as one week up to a year), an epidural can be very effective in providing relief from an acute episode of sciatic pain. Importantly, it can provide sufficient relief to allow a patient to progress with a conditioning program. - Conservative care specialists
Treatment with a physical therapist, osteopathic physician, chiropractor or physiatrist can be helpful both to alleviate the painful symptoms and to help prevent future recurrences of sciatica. These conservative care professionals can assist in providing pain relief and developing a program to condition the back.
Surgical treatments
If the pain is severe and has not gotten better within six to twelve weeks, it is reasonable to consider spine surgery. Depending on the cause and the duration of the sciatic pain, one of two surgical procedures may be considered: a microdecompression (microdiscectomy) or an open decompression (lumbar laminectomy).
Microdiscectomy (microdecompression)
In cases where the pain is due to a disc herniation, a microdiscectomy may be considered after 4 to 6 weeks if the pain is not relieved by conservative means. Urgent surgery is only necessary if there is progressive weakness in the legs, or sudden loss of bowel or bladder control. A microdiscectomy is typically an elective procedure, and the decision to have surgery is based on the amount of pain and dysfunction the patient is experiencing, and the length of time that the pain persists. Approximately 90% to 95% of patients will experience relief from their pain after this type of surgery.
Lumbar laminectomy (open decompression)
If the sciatica is associated with spinal stenosis, surgery may be offered as an option if the patient’s ability to maintain a normal level of activity falls to an unacceptable level. Again, surgery is elective and need only be considered for those patients who have not gotten better after conservative treatments. After a lumbar laminectomy (open decompression), approximately 70% to 80% of patients experience relief from their pain.
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For a full range of information and illustrations on the back and spine, see www.spine-health.com.
