What is sciatica?
Sciatica is a term that describes pain radiating down the leg caused by irritation or compression of one or more spinal nerves that make up the sciatic nerve. The sciatic nerve is the major nerve of the leg, responsible for sensation of the entire leg and function of all leg muscles. The sciatic nerve is made up of spinal nerves L4 to S3. Irritation of any of those spinal nerves can be felt as pain running down the leg, or course of the sciatic nerve. This pain is referred to as sciatica.
What are the symptoms of sciatica?
Patients will usually sense intense pain radiating from the buttocks to the back of the thigh or calf. Sometimes the pain will radiate to the foot. The pain may be constant, may increase with activity or may diminish with sitting or resting. If nerve compression is severe it can affect muscle function. If weakness in the leg or foot occurs, such as a foot drop or dragging foot, one should seek medical attention urgently. If bowel or bladder incontinence occurs it is a medical emergency.
What causes sciatica?
Anything that can cause irritation or compression of the spinal nerves making up the sciatic nerve can cause sciatica. Commonly, sciatica is caused by a herniated disc. The herniated disc material can directly compress the spinal nerve. Sometimes, arthritis of the vertebral joints, the facets, can cause enlargement of the joint, compressing the nerve. Often times it’s a combination of the two.
How is sciatica evaluated?
The first step in the evaluation of sciatica is a careful history and physical. An MRI will usually identify the region of the spine where the nerve compression or irritation causing the sciatica is. An MRI is indicated in patients who do not improve with conservative means or patients with severe symptoms.
How is sciatica treated?
Medications and therapy are the first line in the treatment of back pain. In patients that don’t respond a spinal pain management evaluation can be performed. In this highly specialized evaluation, we determine which spinal nerve is involved and what the cause is. Spinal injections can bring relief and confirm the source of pain. Often, a spinal injection will bring relief long enough for the nerve to heal on its own. Minimally invasive surgery is reserved only for cases that do not improve with spinal injections.
The following spinal injections can be used to treat sciatica:
The following minimally invasive surgical procedures can be used to treat sciatica: