Sciatica

What is it?

Sciatica is characterized with pain that occurs when there is damage to or pressure on the sciatic nerve. The sciatic nerve is formed by nerve roots that extend out of the spinal cord into the lower back, down the legs, to the feet. Causes of sciatica include, among others, herniated disc, spinal tumor, spinal stenosis, and pelvic fracture.

Symptoms

Symptoms of sciatica may include pain in the back, buttocks, legs, or feet. Sciatica also can cause leg weakness, tingling, and numbness. It is frequently worse after sitting. In very advanced cases of sciatica, the symptomatology is characterized by any of the following:

  • Loss of bowel or bladder control
  • Pain that is worse when cough or sneeze
  • Numbness or weakness in the legs
  • Pain not relieved within a couple weeks by rest or the medications.

Diagnosis

During the physical exam, a spine doctor might check a muscle strength and reflexes. For many people, their sciatica gets better with time and symptoms go away, however, people with severe pain or pain that doesn’t improve within a few weeks may need X-ray, MRI, CT scan, and electromyography (EMG), to determine the cause of sciatica.

Treatment

For pain that doesn’t improve with self-care measures, the following treatments might be helpful:

  • Medications (anti-inflammatories and corticosteroids)
  • Physical therapy
  • Steroid injections

If sciatica does not respond to nonsurgical treatments, surgery to address the underlying medical condition may be the best option. Depending on what’s causing the pain, spinal surgeon may recommend the following procedures, alone or in combination:

  • Discectomy, or microdiscectomy, is a minimally invasive procedure to remove part of a spinal disc, if the sciatica is caused by a herniated lumbar disc.
  • Laminectomy is a procedure to create more space for the nerves by removing the lamina (or roof) of one or more vertebrae, if sciatica pain is caused by lumbar spinal stenosis.
  • Foraminotomy is a procedure to remove the pressure from a nerve root by removing a small portion of bone around the affected nerve root.
  • Spinal fusion, a surgery in which two or more vertebrae are permanently joined together.