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.
Because these nerves travel to the hips, buttocks, legs, and feet, an injury in the lumbar spine can cause symptoms in these areas. Nerve root injury may occur at any of the five vertebrae in the lumbar spine, the L1 through the L5, or at the level of the sacrum, the upper portion of which is called the S1.
Sciatica is not a diagnosis, but rather a description of symptoms including leg pain, tingling, numbness, or weakness that travel down the low back via the sciatic nerve in the back of the leg.
Causes of Sciatica
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 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 help relieve the leg pain and weakness.
Symptoms of Sciatica
Symptoms may include
- 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 and also foot weakness where the foot slaps the ground or the toes drag (foot drop). And finally, damage at the S1 level can create pain from the calf to the outer foot, underside of foot, and also foot weakness on push off.
For proper diagnosis, your doctor will ask you questions about your medical history and more specific questions about the onset of your pain and other symptoms. Your doctor will also conduct a complete physical exam, checking for localized pain in the low back, buttock, thigh, and leg. Additionally, your doctor may conduct certain clinical tests to check for sciatic nerve pain. These tests may include a straight leg raise test and a slump test
Medical imaging tests may be ordered 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 boney 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.
Treatment for Sciatica
At CalSpine MD, Dr. Ball offers a full range of nonsurgical and surgical treatment options for sciatica.
Nonsurgical Treatment for Sciatica. Nonsurgical treatment for sciatica may include the following:
Anti-inflammatory Medications. Medicine such as ibuprofen, naproxen, celecoxib may help to decrease pain and inflammation of the nerve roots.
Prescription and 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. 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 nonsurgical treatment does not improve symptoms, surgery may be considered.
Surgical Treatment for Sciatica. At CalSpine MD, Dr. Ball offers a few different surgical approaches for sciatica, such as the following:
Some surgical options may include the following:
Microdiscectomy. A microdiscectomy is recommended when sciatica is caused by a lumbar disc herniation. During this procedure, your doctor removes a small part of the disc material compressing the nerve root and/or 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, need 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.