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.
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.
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.
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.
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.