Sciatica

Sciatica refers to pain that radiates along the path of the sciatic nerve, which runs from your lower back, through the hips and buttocks, and down each leg. It is important to note that sciatica itself is not a diagnosis but rather a symptom of an underlying issue in the lower spine.

The pain can vary from mild to severe and is often accompanied by numbness, tingling, or weakness in the affected leg. It can make everyday activities challenging.

At CalSpine MD, Dr. Hieu Ball offers effective, personalized treatments to help you manage and relieve sciatica pain. Whether your discomfort is occasional or more persistent, we will work with you to develop a tailored treatment plan. 

Treatment options may include physical therapy, medications, injections, or surgery if necessary, depending on the cause and severity of your symptoms.

Sciatica or lumbar radiculopathy is an irritation or compression of one or more of the nerve roots in the lumbar spine. The lumbar spine (lower back) consists of five vertebrae labeled L1 through L5. 

These nerve roots branch out and travel through the hips, legs, and feet, which is why an injury or issue in the lower spine can cause symptoms in these areas. Nerve root injury may occur at any of the five vertebrae in the lumbar spine, from L1 through L5, or at the level of the sacrum, the upper portion of which is called the S1. 

When this happens, you may experience symptoms like leg pain, tingling, numbness, or weakness that radiate down the back of the leg.

Some common causes of sciatica include a herniated disc, degenerative disc disease, and spinal stenosis.

• Herniated Disc: A herniated disc is a common cause of sciatica. It is a rupture in the fibrous outer wall of a vertebral disc, which allows the soft nucleus pulposus of the disc to bulge outward. This bulge can press harmfully against a nerve root and result in pain shooting down the thigh, calf, and foot.
• Degenerative Disc Disease: Degenerative disc disease is another common cause of nerve root injury. It occurs when a spinal disc weakens, allowing vertebral bones above and below the disc to shift out of position. The bones can touch, and this vertical loss of height can affect the nerve roots by collapsing and pinching nerve roots as they emerge from the spinal canal and travel down through the buttocks, thighs, calves, and feet.
• Spinal Stenosis: When bones, discs, or joints of the spine degenerate, bony spurs may form and push into the central spinal canal or the foraminal space. This is called spinal stenosis, and it can also create harmful pressure against the nerve roots or cauda equina, causing shooting pain or sciatica.  It may also cause difficulty walking for long distances due to the feeling of weakness or fatigue in both legs. Often, patients find that curling up into a fetal position or leaning onto a counter or shopping cart helps relieve the leg pain and weakness.

Symptoms of sciatica may include

• Pain
• Weakness  
• Numbness and tingling
• Loss of endurance in standing or walking

Symptoms may also vary depending on the level of the injury. Every disc level maps to an anatomic region in the legs. 

For example, an injury at the L2 level can create thigh pain and hip weakness. An injury at the L3 or L4 level may result in thigh pain and knee and thigh weakness. Damage at the L5 level can create pain from the outer leg to the top of the foot, as well as foot weakness, where the foot slaps the ground or drags the toes (foot drop). Finally, damage at the S1 level can create pain from the calf to the outer foot and the underside of the foot, as well as foot weakness on push-off.

For proper diagnosis, we will ask you questions about your medical history and more specific questions about the onset of your pain and other symptoms. Our team will also conduct a complete physical exam, checking for localized pain in the low back, buttocks, thigh, and leg. 

Additionally, we may conduct certain clinical tests to check for sciatic nerve pain. These tests may include a straight leg raise test and a slump test.

We may order the following medical imaging tests if sciatica is suspected:

• MRI scan: An MRI (magnetic resonance imaging) scan allows the doctor to visualize the sciatic nerve, surrounding soft tissues, and facet joint capsules. The spinal cord and other soft tissues are best seen with this method of imaging. There is no radiation associated with MRIs.
• Radiographs or X-rays: Simple imaging studies may help assess the bony anatomy around diseased segments of the spine. They are helpful in determining if a segment is unstable, or if a deformity such as scoliosis is present that may be contributing to the compression of the nerves.

At CalSpine MD, we offer a full range of non-surgical and surgical treatment options for sciatica.

Non-surgical treatment for sciatica may include the following:

• Anti-inflammatory Medications: Medicines such as ibuprofen, naproxen, and celecoxib may help decrease pain and inflammation of the nerve roots.
• Prescription & Over-the-Counter Medications: These help to decrease sciatic pain and allow patients to participate in physical therapy. 
• Physical Therapy: Helps to strengthen the spine and muscles of the lower back, abdomen, buttocks, and hip, increase core strength, build endurance, and increase flexibility.
• Chiropractic Therapy: Manual manipulation aims at improving the alignment of the spine and may help address underlying conditions that can cause sciatic nerve pain such as a herniated disc or spinal stenosis. 
• Epidural Steroid Injections: These injections help relieve sciatic pain from conditions such as spinal stenosis, a herniated disc, or degenerative disc disease by minimizing inflammation around the irritated nerve roots.

If an extended period of non-surgical treatment does not improve symptoms, surgery may be considered.

At CalSpine MD, Dr. Ball offers a few different surgical approaches for sciatica. Common surgical options may include the following:

• Microdiscectomy: A microdiscectomy is recommended when sciatica is caused by a lumbar disc herniation. During this procedure, Dr. Ball removes a small part of the disc material, compressing the nerve root and/or the bone over the nerve root. 
• Lumbar Laminectomy: A lumbar laminectomy is recommended when sciatica is caused by lumbar spinal stenosis. During this procedure, Dr. Ball removes any bone, bone spurs, or ligaments that are putting pressure on the nerves. The back part of the vertebra, called the lamina, is partially removed, creating more space in the spinal canal for the nerves without sacrificing the stability of the spine, so no hardware (screws, rods) need to be placed. 
• Foraminotomy: Sometimes the foramen, the area where the nerve roots exit the spinal cord, needs to be enlarged by removing bony overgrowth, providing more room for the nerve root. 
• Facetectomy: In cases where the sciatic pain is caused by degenerated facet joints, the facet joints are trimmed, undercut, or removed to relieve nerve pressure on the pinched nerves. 

Whatever may be causing your sciatic nerve pain, Dr. Ball will help you choose the best surgical option that is right for you, your lifestyle, and your current condition.

At CalSpine MD, we understand how disruptive sciatica can be, whether it is limiting your mobility, interfering with work, or affecting your day-to-day comfort. With over 20 years of surgical experience, Dr. Hieu Ball brings advanced skill and deep expertise to the diagnosis and treatment of sciatica.

To schedule an appointment, please call CalSpine MD at (925) 838-8830. You may also request an appointment online.