What Is Sciatica?
Sciatica, or sciatic neuritis, is a set of symptoms including pain that may be caused by compression and/or irritation of one of five spinal nerve roots that give rise to the sciatic nerve. The sciatic nerve is one of the largest nerves in the body that starts in the low back region and travels down through the buttocks, and along the back of the leg all the way to the foot. Thus, the pain is often felt in the lower back, buttock, and/or various parts of the leg and foot. There may be numbness, weakness, pins and needles or tingling, and difficulty with moving and controlling the involved leg. Typically, the symptoms are only felt on one side of the body.
Although sciatica is a relatively common form of low back pain and leg pain, it is a set of symptoms rather than a diagnosis for what is causing the nerve root irritation and pain. Therefore, the treatment for sciatica or sciatic symptoms will differ greatly depending on the underlying cause of nerve root related pain and disability.
Signs and Symptoms
Sciatica pain can vary widely. It may cause a mild tingling, dull ache, or a burning sensation. The pain may be severe enough to make a person avoid any type of movement. As mentioned above, the pain most often occurs on one side of the body. Burning or numbness and tingling may accompany the pain down the leg. Sneezing, coughing, or laughing may make the pain worse. Although rare, loss of feeling or weakness in the leg, as well as loss of bowel or bladder control, may be due to another condition called cauda equina syndrome. This is a medical emergency and requires prompt medical attention.
Causes
Sciatica occurs when there is pressure or damage to the sciatic nerve. Some of the common causes of sciatica include:
- Piriformis syndrome (a pain disorder involving the narrow piriformis muscle in the buttocks that presses against the sciatic nerve)
- Herniated disc
- Degenerative disc disease
- Lumbar stenosis
- Spondylolisthesis
- Spondylosis (arthritis of the spine)
- Pelvic injury or fracture
- Tumors
- Pregnancy
Diagnosis
Dr. Cho carefully examines each patient who initially presents with sciatica to determine the underlying cause of symptoms. Other tests such as x-rays and MRI may be needed to confirm the suspected cause of the dysfunction, as suggested by the history, symptoms, and pattern of symptom development.
Non-surgical Treatment
Many patients suffering from sciatica can be successfully treated without surgical intervention. Some of the non-operative treatments include exercise, physical therapy, various modalities (heat treatments, massage therapy, and manipulation), and the use of pain medications, such as muscle relaxants, non-steroidal anti-inflammatory drugs, Tylenol, or a short course of steroids. Nerve root blocks and epidural steroid injections may be used if there is significant leg pain arising from pinched nerve(s).
Surgical Treatment
Dr. Cho only recommends surgery when there is an identifiable source of pain that is debilitating in nature and/or causing nerve irritation or damage. The type of procedure offered may differ depending on the cause of sciatica, ranging from minimally-invasive endoscopic discectomy to conventional spinal decompression and fusion.