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Sciatica
Overview/Definition
Symptoms
Potential Causes
Diagnosis
Treatment Options
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Overview/Definition
Sciatica (technically known as lumbar radiculopathy) refers to pain in the
distribution of the sciatic nerve, the largest nerve in the body (about the
width of a finger). Commonly, the pain begins in the low back, runs down
the buttock and down the leg. It may be caused by many conditions, but the
most common is a protruding disc that presses on the sciatic nerve.
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Symptoms
Sciatic pain may be dull, sharp, burning or accompanied by intermittent shocks
of shooting pain most commonly felt in the low back, and traveling down the
back of one the thighs and into the leg. The pain may extend below the knee,
sometimes all the way to the feet. Symptoms may include weakness, numbness,
or a “pins and needles” sensation. Sitting and trying to stand
up may be painful and difficult. Sneezing or coughing may intensify the pain.
Typically, sciatica affects just one side of the body.
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Potential Causes
Sciatica most often results from general wear and tear or sudden pressure
on the discs that cushion the vertebrae of the lower spine. A herniated disc
may press directly on the nerve roots that lead into the sciatic nerve. The
damaged disc can also leak fluid, which may inflame and irritate the nerve.
Other less common causes of sciatica include: Degenerative
Disc Disease,
Lumbar Spinal Stenosis, Isthmic Spondylolisthesis, Sacro-iliitis, Lumbar
Facet Joint Syndrome, Piriformis Syndrome and Iliolumbar Syndrome. In rare
cases, it can also be caused by infection or tumor.
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Diagnosis
The physician’s examination includes the patient’s medical history,
a review of current medications, a physical and neurologic examination and,
if warranted, X-rays, a CT scan and/or an MRI. A proper diagnosis requires
an analysis of the patient’s pain.
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Treatment Options
Treatment aims to help the patient manage pain without long-term use of medications.
A few days of bed rest may be recommended during the acute phase. In addition,
some light intermittent activity during this period, such as standing and
walking, will also help to reduce inflammation, as long as it does not cause
severe pain. Applying gentle heat or cold on the painful muscles may help
soothe the pain. Your doctor may also recommend injecting the spine area
with a cortisone-like drug. Physical
therapy and short walks may also be
recommended. In most cases, this conservative approach will improve the condition
within a few weeks.
If conservative treatment proves ineffective in managing your leg pain, surgery
may be recommended. Laminotomy is the most common surgical treatment for
sciatica caused by a herniated disc. Surgery for disc herniation is almost
always an elective quality of life decision.
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