Sciatica

The sciatic nerve branches from the spinal cord at the lumbar and sacral regions. The lumbar spine, located in the lower back, consists of five large vertebrae that form the curve just below the waist. The back of each vertebra has an arch called the lamina, which protects the spinal canal.

Between the lumbar vertebrae are six intervertebral discs made of resilient connective tissue. The discs feature a tough outer layer known as the annulus fibrosus and a gel-like center called the nucleus pulposus. These structures, along with small spinal facet joints, connect the vertebrae and enable movement while providing stability and shock absorption.

The central openings in each vertebra create the spinal canal, through which the spinal cord and nerves travel. The sciatic nerve is formed by several nerve roots that exit the spinal cord and travel down through the buttocks, thighs, legs, and into the feet. It is responsible for controlling muscles in the back of the knee and lower leg, as well as sensation in the back of the thigh, calf, and sole of the foot.

Sciatica can result from several factors that irritate or compress the sciatic nerve. Common causes include:
Trauma: Injuries, such as pelvic fractures from motor vehicle accidents, can directly affect the nerve.
Medical Conditions: Conditions like diabetes, tumors, pregnancy, or obesity may contribute to sciatic nerve pain.
Spinal Conditions: Disorders such as spinal stenosis, arthritis, spondylolisthesis, degenerative disc disease, and herniated discs can alter the spine and lead to sciatica.

Spinal stenosis involves narrowing of the spinal canal, which can compress the sciatic nerve roots. This condition often results from age-related degeneration of the spine. Arthritis can also cause bone spurs that encroach on the nerve, while degenerative disc disease leads to a loss of cushioning and height in the discs, which can further irritate the sciatic nerve.

A herniated disc occurs when the outer layer of the disc tears, allowing the inner gel-like material to protrude. This can exert pressure on the nearby nerve roots, causing pain and inflammation.

The hallmark of sciatica is severe pain, typically originating deep in the lower back and radiating down one side of the body. Pain may extend from the buttock down the back of the leg, often feeling more intense than the pain in the back itself.

Other symptoms can include burning sensations, tingling, weakness, or numbness in the calf, foot, or toes. In some cases, the discomfort can be so severe that it hampers movement, making it difficult to stand up from a seated position or walk. Symptoms may worsen with actions like sneezing, coughing, laughing, or bending backward.

In rare instances, significant weakness in the legs or loss of bowel and bladder control may indicate a serious issue requiring immediate medical attention.

To effectively treat sciatica, identifying the underlying cause is crucial. A healthcare provider will perform a physical examination and inquire about symptoms and medical history. Simple movements may be assessed to evaluate muscle strength and joint stability, along with reflexes and sensation.

Diagnostic imaging may include X-rays to examine vertebrae and detect issues such as narrowed discs. A myelogram, which involves injecting dye into the spinal canal, can highlight areas of nerve compression. Other imaging techniques like CT scans or MRIs provide detailed views of spinal structures and can detect conditions affecting the sciatic nerve.

Nerve conduction studies (NCS) measure how well the sciatic nerve transmits signals, while electromyography (EMG) assesses the electrical activity of muscles controlled by the nerve, helping to diagnose nerve and muscle issues.

Most individuals with sciatica can find relief through non-surgical methods aimed at reducing pain and alleviating nerve pressure. Initial recommendations may include rest, over-the-counter medications, or prescribed pain relief options. If symptoms persist, your doctor might suggest corticosteroid injections for more significant relief.

Physical therapy is often recommended, with therapists providing treatments to alleviate pain and exercises to strengthen muscles. Staying active is crucial, as movement helps reduce inflammation.

Surgery is considered when conservative treatments yield minimal results or when there is severe nerve compression causing significant dysfunction and pain. The specific type of surgery will depend on the underlying diagnosis, which your surgeon will discuss with you to determine the best approach.

Post-surgery recovery varies based on the procedure performed. Your physician will provide guidelines on what to expect. Many patients engage in physical therapy post-operatively, focusing on exercises to strengthen back and leg muscles. With appropriate rehabilitation, most individuals achieve satisfactory outcomes and return to their normal activities.