Sciatica

Sciatica

What is Sciatica?

Sciatica is a condition that occurs when nerve roots are compressed or irritated in the area of the spine located in the lower back. This condition is also called lumbar radiculopathy. Lumbar refers to the area of the spine in which it occurs, while radiculopathy is the word used to describe pain, weakness, tingling and numbness caused by irritation of the nerve roots.

What causes Sciatica?

Nerve roots are the area of nerves where they branch off from the spinal cord to connect to different parts of the body. The nerves send signals to the brain to create sensations, like texture or pain. Irritation or compression of the nerve roots is usually caused by disc herniation or degenerative changes to the spine that put pressure on nerve roots.

Conditions that may causes compression in the lumber area of the spine vary, but can include herniated disc, degenerative disc disease, and spinal stenosis. When the roots of the nerves are compressed, it causes muscle weakness, pain and numbness in the area connected to the affected nerves.

Symptoms and Diagnosis

When the roots of the nerves are compressed anywhere along the spine, it causes muscle weakness, pain and numbness in the area connected to the affected nerves. The nerve roots in the lumbar area of the spine branch off the spinal cord and through the boney structure that protects them out to the feet, legs, hips, and buttocks. This means that compression of those nerve roots may cause pain or other sensations in the feet, legs, hips, and buttocks.

Symptoms vary depending on where the nerve roots are being compressed, but commonly include pain, weakness, tingling, or numbness. The area where these symptoms are felt may depend on where in the spine the nerve roots are compressed. Each vertebrae in the spine is assigned a numbered level. The 5 vertebrae in the lumbar section are L1 through L5, while the sacrum is S1. The locations of symptoms can vary depending on where the nerve roots are compressed, as the nerve roots in each level correspond to different places. Below is a list of symptoms you may experience depending on the level at which your sciatica is occurring:

  • L2 - hip weakness and pain in your thigh
  • L3 - weakness in your knee, as well as pain and weakness in your thigh.
  • L4 - foot weakness and pain that travels from the lower back down to the knee or foot.
  • L5 - pain down the outside of your leg to the top of your foot or big toe, as well as foot weakness
  • S1 - weakness in your foot and pain down the back of your calf to the outside of your foot and little toe

To diagnose sciatica, a physician will review a patient's medical history, asking about the location and type of the symptoms to help determine if a nerve root is being affected. A physical exam will follow, focusing on range of motion and flexibility, as well as muscle strength, sensation, and reflexes to determine what nerve root is being compressed.

To verify the diagnosis, several tests may be needed. An X-ray will be performed first, which can help identify the presence of trauma or osteoarthritis, as well as early signs of infection or tumor growth. A CT scan or an MRI may follow. A CT scan can show the amount of space nerve roots are allotted by the foramen, or openings in the vertebrae of the spine. An MRI scan can best reveal the location and extent of nerve compression because it is designed to show the soft tissues around the spine, including discs, ligaments and nerves.

How is Sciatica treated?

Symptoms of sciatica can often be relieved by conservative treatments like anti-inflammatory medication, physical therapy, and rest. Bracing may be prescribed. Most patients respond well to this treatment, with symptoms improving from six weeks to three months. However, if there is evidence of nerve damage or if symptoms fail to improve over time, surgery may be needed to remove pressure from the spinal roots. The procedure needed varies according to the source of the nerve root compression and its location in the spine.


All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

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Sciatica

Sciatica

You may be a candidate for Endoscopic Discectomy

Sciatica

Sciatica (pronounced sigh-at-eh-kah) has quickly gained infamy as a very common condition, affecting over 3 million people per year in the United States. However, by understanding the various symptoms and causes of sciatica, as well as the available treatments, you can make confident and knowledgeable decisions about this generally manageable complication. The sciatic nerve runs from the lower region of the spine down the back of each leg. As the longest nerve in the body, the sciatic nerve provides sensation to the backs of the thighs, parts of the legs and the feet. Additionally, it controls the muscles around the backs of the knees and the lower legs. When the sciatic nerve is pressured or damaged in any way, sciatica occurs. Pain can vary widely, sometimes appearing as a light tingling, a dull aching or even a burning feeling known as lumbar radiculopathy. Rarely, the pain can become so severe that a patient is immobilized. Other symptoms include, but are not limited to:
  • Lower back pain
  •  Pain in the rear or leg that intensifies when standing or sitting
  • Hip pain
  • Weakness, numbness or difficulty moving the leg or foot
  •  A constant pain on one side of the rear
  •  Sensations that make it difficult to stand from a sitting position
  •  A “pins-and-needles” feeling
 
Pain located in one side of the body and not in the other is usually a good indicator of sciatica as each sciatic nerve operates independently of the other. Some distinct symptoms, such as pain bending the body forward or backward, may appear depending on the origin of your sciatica.

Sciatica Causes

The underlying causes can be as various as its symptoms. However, some of the most common instigators are:

As discs in the spine age, they begin to show wear and tear. This process can be accelerated by other factors and may cause sciatica as your spinal makeup begins to change.

Also known as a “slipped” or ruptured disc, a herniation occurs when a tear in the disc’s hard outer layer, known as the annulus, allows the inner liquid-like nucleus to leak into the spinal canal. Pressure results and, if located near the sciatic nerve, can lead to sciatica. Herniated discs usually happen because of strenuous labor or everyday tasks that are physically straining.

Sciatica may be caused by spinal stenosis, or the narrowing of the spinal canal. When spinal stenosis occurs, tension is placed on the spinal cord and may irritate and strain local nerves.

  • Piriformis Syndrome

The slim piriformis muscle is located in the buttocks, near the hip joint, and helps people move their thighs, maintain balance and walk. The sciatic nerve travels closely to this muscle and can easily become pressed or irritated when the piriformis spasms or contracts. Runners and other athletes are especially susceptible to this type of trigger.

Occasionally, a vertebra in the spine can slip forward and slide over the bone beneath it. This condition is known as spondylolisthesis and is most common in the lower back, where straining nearby nerves can cause sciatica.

  • Sudden injury or accident

Some unexpected traumatic events, such as a car accident, can lead to sciatica. Injuries sustained and new scar tissue can place stress on the sciatic nerve.

  • Pregnancy

During pregnancy, pain in the back of the thighs spurred by shifts in the pelvic region can be misdiagnosed as sciatica. However, there are situations in which the sciatic nerve is actually being pressed as a result of these changes. Speak to your doctor if you think you are suffering from sciatica or pelvic groin pain.

  • Infection

Rarely, an infection in the spine may cause sciatica.

  • Other health issues, such as tumors

Growths and related health issues may irritate the sciatic nerve and lead to chronic sciatica.

Sciatica Symptoms

Symptoms often include:

  • Mild tingling sensations throughout the leg, calf or foot
  • Dull, aching pain throughout the leg, calf or foot
  • Burning sensations, known as lumbar radiculopathy
  • Sharp pain in parts in the leg or hip
  • Weakness and numbness in the affected leg

Sciatica Non-Surgical Treatment Options

How you address sciatica depends largely upon the root cause. Luckily, there are many methods that may lessen the pain of sciatica or remove it entirely. Many treatment plans involve one or more of the following:
  • Physical therapy and massage therapy
Strengthening exercises, aerobic conditioning and targeted massage provide remedies to many men and women suffering from sciatica. Empowering the spinal column and abdominal core as well as related muscles, ligaments and tendons through purposeful exercise can reduce pressure on the sciatic nerve. Massages from licensed professionals may relieve tension and reduce inflammation.
  • Anti-inflammatory medications
Some anti-inflammatory medications may help mitigate the pain and severity of sciatica, but be sure to discuss all potential pharmaceuticals with your doctor before using them. Failing to do so may result in an even worse case of sciatica or other serious consequences.
  • Lifestyle changes
Altering your behavior and environment in certain ways can help the body deal with sciatica and may keep your condition from worsening. Drink lots of water and eat a diet high in healthy proteins and Omega 3 fatty acids, which have anti-inflammatory properties. Avoid prolonged periods of bed rest, as they tighten your muscles and can lead to even greater irritation. Maintain proper posture and stretch regularly. Do not smoke, as doing so can heighten your risk for disc degeneration and sciatica relapses.
  • Epidural steroid injections
Epidural steroid injections (ESIs) can significantly reduce pain and will likely be used in tandem with a rehabilitation program to treat sciatica. Although ESIs provide only temporary relief, some people who have acute sciatic episodes may find them beneficial until a more permanent solution is reached.

Sciatica Surgical Treatment Options

If conservative treatments do not ease your sciatica-related pains, you may consider undergoing minimally invasive surgery. Minimally invasive procedures focus on removing the condition instead of only treating the symptoms. These approaches also prioritize extremely small incisions and shortened recovery times.

Common minimally invasive surgeries are:

  • Epidural steroid injections

An Endoscopic microdiscectomy involves trimming and removing fragments of intervertebral discs that have broken away and are pressing on the sciatic nerve or spinal cord.

  • Endoscopic Decompression

Sometimes, a portion of the arthritic vertebral bone and thickening of the ligament inside the spinal canal will be trimmed or removed to curtail sciatica.

When compared with traditional open operations, our Microspine & Minimally Invasive technique yield:

  • Shortened recovery times that allow patients to return to work, school and other daily activities faster
  • Less post-operative pain
  • A reduced risk of scarring and blood loss
  •  Minor trauma to surrounding tissues, leaving the majority of muscle unaffected
  •  Fewer potential complications

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