Sciatica

What is Sciatica?

Sciatica refers to pain in the legs and buttocks that occurs due to a compressed nerve or nerve root. The sciatic nerves run down the length of each leg and are the longest and largest nerves in the body.

While they actually start in the buttocks, the nerve roots that eventually become the sciatic nerves branch off the spinal cord in the lumbar and sacral spine. Compression of either or both sciatic nerves or the nerve roots that form them can lead to pain in the legs and buttocks, as well as numbness, tingling, weakness and other symptoms. 

Causes and Risk Factors

Sciatica is caused be compression of either the nerve itself or the nerve roots that become the sciatic nerve. Compression of nerve roots are usually due to:

Sciatic nerve compression can occur due to a fractured pelvis or tight hip muscles (piriformis syndrome).

Symptoms

Pain that radiates (called radiculopathy) from the lower back and into the legs is the main symptom of sciatica. The pain can be sharp or dull. It can feel like burning or an electric shock.

Usually only one leg or side of the body is affected. Other symptoms can include numbness, tingling or weakness in one of the legs or feet. 

Diagnosis

It is not the sciatica itself but the root cause that needs to be diagnosed. Having a proper diagnosis as to what is causing the sciatica will inform treatment options. 

Diagnosis usually starts with a physical exam, looking for signs and symptoms. The doctor may perform a neurological exam to test muscle function and reflex time.

Imaging tests may be ordered after the exam. X-rays can show the presence of bone spurs and can rule out other sources of pain. Magnetic resonance imaging (MRI) and computed tomography (CT) scans can show soft tissue problems such as herniated discs and ligament thickening that causes spinal stenosis.

Treatment 

Most cases of sciatica–80 to 90 percent, according to the American Academy of Orthopaedic Surgeons–resolve on their own in a matter of weeks after the onset of pain. If pain persists, conservative treatments are usually attempted first, and can include: 

  • Cold or heat
  • Exercise, stretching and physical therapy
  • Over-the-counter anti-inflammatories
  • Muscle relaxants
  • Steroid injections

Surgical treatment will depend upon the root cause of sciatica. A laminectomy can be a surgical treatment for either bone spurs or spinal stenosis. During a laminectomy, a surgeon will remove the back of a vertebra called the lamina. This will open up the spinal canal and give nerve roots more room in the case of spinal stenosis, and also remove bone that has developed bone spurs. 

For herniated discs, surgeons may perform a discectomy, often with the assistance of a microscope (a procedure called microdiscectomy). This involves cutting out the herniated portion of the disc that is pressing on the nerve root, along with any disc fragments that may have broken off.

At Edison Spine Center, we specialize in laser disc decompression. A needle is inserted through the skin and into the disc, and laser heat energy is delivered to the inner portion of the disc to vaporize a portion. This changes the pressure inside the disc, causing the bulging section to retract. One major advantage of laser disc decompression is that it involves no incisions and no rearrangement of muscles, tendons or facet joints. 

If you are experiencing radiating pain in your legs or buttocks, request an appointment with Edison Spine Center. We will diagnose the cause of your sciatica and recommend a treatment plan that works for you and your life circumstances.