As many as 40% of Americans experience some form of sciatica at one point in their lives. Sciatica is a symptom and is described as pain that often starts in the lower back and travels down the buttocks, hips and legs. Often time the symptoms are unilateral but depending on the cause of sciatica, symptoms may be bilateral. The term sciatica comes from the sciatic nerve which is a large nerve originating from multiple nerves of the lumbar spine that travels through the buttocks to each of the legs. Radiculopathy is the medical term that is often used to describe sciatica.
There are many reasons someone may suffer sciatic pain. The underlying pain occurs because of some irritation and/or compression of the nerves that start in the lumbar spine (lower back) and travel to the legs. These nerves send pain, sensation and motor signals from your legs to your spine and eventually your brain. Therefore, if there is irritation or dysfunction of the nerve patients may experience the pain, numbness, tingling and/or motor dysfunction. Some common causes of sciatica include neuritis (intrinsic inflammation of the nerve), compression of the nerve by arthritis or bone spurs of the spine, and herniated disks that cause inflammation and/or compression of the nerve. Less common causes may include fractures, infection or tumors.
Importantly, other medical issues such as peripheral neuropathy and vascular disease can often mimic symptoms of sciatica. Therefore, if you have sciatic type symptoms it is important to see a physician who can help determine the cause of your pain.
Remember that sciatica is a symptom and your doctor will often use multiple tests to determine the cause of your symptoms. Usually a trial of conservative therapies for many weeks is indicated prior to doing an exhaustive workup as most patients with sciatic symptoms will have resolution of their symptoms without significant intervention. For persistent symptoms, your doctor may initiate a workup depending on your exact symptoms, timing, medical history and physical exam. One of the most commonly used tools is an MRI of the spine. This allows the physician to see the structures in the lower back including the nerves, disks, joints and bones. Sometimes a nerve study or EMG/NCV is helpful. This test measures the function of individual nerves in the legs and can be helpful in discriminating between peripheral neuropathy and sciatica. Xrays, blood tests, vascular studies or CT bone scans may also be helpful.
As mentioned above, the first step in treatment of patients with sciatic symptoms is often conservative measures. This is because the body has significant capacity to heal itself and many times sciatic symptoms will resolve with minimal intervention. Furthermore, all medications and treatments have potential for side effects and risks which you should discuss with your physician.
Some conservative measures that may be tried include non-steroidal anti-inflammatory medications (NSAIDs) such as Ibuprofen or Aleve that can be helpful to reduce nerve inflammation that may be responsible for the pain.
Physical therapy can be very helpful to relax tense muscles that occur due to nerve irritation as all muscles are innervated by the nerve that controls them. Physical therapy can also promote proper posture and strengthen the supporting muscles of the spine to help decrease the likelihood of a future injury. Some patients find relief with chiropractic care or acupuncture.
Nerve pain medications such as Gabapentin or Lyrica may be used. These medications can be good for nerve pain as they work to decrease pain signals in nerves. Opioid medications may be used in severe cases for a very short duration but their use and effectiveness is often limited.
Depending on the cause of sciatica epidural steroid injections may be considering in moderate to severe cases or in patients in which other treatments have failed. Epidural injections allow for a strong dose of steroid to be placed near the irritated nerves in the lumbar spine that are causing the sciatic symptoms. Sometimes this can help decrease the inflammation around the nerve and resultant pain while the body heals.
If conservative treatments fail sometimes surgery can help relieve sciatic symptoms. In general, surgery is helpful if a patient’s pain can be attributed to compression of one or more of the nerves that start in the back and travel down the legs. Compression of the nerve may occur from a disk herniation, arthritis or stenosis/narrowing of the spinal canal which the nerves run through. It is important to remember that arthritis and bone spurs occur naturally in the aging spine and most of the time do not require any surgical intervention.
Determining if surgery is an appropriate treatment option requires significant knowledge of anatomy, expertise in interpreting MRIs and other studies, consideration of medical co-morbidities, patient history and neurologic exam. Our experts at Axis Brain and Spine specialize in treatment of sciatic pain. Set up a consultation with us to talk through what is right for you!