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What is sciatica?
Sciatica is a condition that results from the compression of several nerve roots in the lumbar spine. This may result from medical concerns relating to the tissues and bones in the lumbar spinal column and can cause daily pain for the patient. Individuals who suffer from sciatica can feel intense symptoms because the nerves connect to the legs, hips, buttocks, and feet.
What causes sciatica?
Sciatica most commonly occurs when a herniated disc, bone spur on the spine, or narrowing of the spinal column (spinal stenosis) compresses part of the nerve. This results in inflammation, pain, tingling, and often numbness down the affected leg served by the nerve. The term sciatica comes from the nerve that is being pinched, the sciatic nerve.
A nerve root injury can happen at any of the vertebrae in the spine, there are five in total. This is referred to as L1 through L5. This type of pain can also occur at the upper portion of the spine or the sacrum. Sciatica symptoms may include weakness, numbness, and tingling. The extent of the pain depends on the injury sustained.
- Damage at the L2 level can create hip weakness and thigh pain.
- Damage at the L3 level can create knee and thigh weakness.
- Damage at the L4 level can cause pain from the lower back to the foot.
- Damage at the L5 level can create pain from the outer leg to the top of the foot.
- Damage at the S1 level can create pain from the calf to the outer foot.
Common Causes of Sciatica:
A herniated disc is a common cause of sciatica. This is formed from a rupture in the outer wall of a vertebral disc, which is a fibrous type of wall. The soft nucleus then begins to bugle outward of the area. The bulge can then harmfully press on the nerve root.
Degenerative Disc Disease
Degenerative disc disease is another cause of sciatica. This nerve root injury occurs with the wearing of the spinal disc. This makes the vertebral bones shift out of position above and below the area. When these bones touch, they pinch the nearby nerve roots.
Spinal stenosis occurs when the discs, joints, or bones of the spine start to fall apart. This can cause bony spurs to form, which are then pushed into the spinal canal. Spinal stenosis can lead to potentially harmful pressure being pushed against the nerve roots.
What are the risk factors for sciatica?
These conditions make it more likely that you may develop sciatica:
- Age — Age-related changes in the spine (issues such as herniated discs and bone spurs) are the most common causes of sciatica.
- Obesity — Excess weight places more stress on the spine.
- Occupation — There is some thinking that jobs that require you to twist your back, carry heavy loads, or drive a vehicle for long periods of time contribute to sciatica.
- Prolonged sitting — If you have a sedentary lifestyle or have to sit for prolonged periods of time, you’re more likely to develop sciatica.
- Diabetes — Because diabetes affects the way your body uses blood sugar, this increases your risk for nerve damage.
How long does sciatica last?
It’s estimated that up to 40 percent of people will experience sciatica at least once in their life. The good news is that for most people, surgery is not necessary, and the pain will resolve within about 6 weeks. These cases are usually relatively mild and are probably “acute sciatica.”
However, if your symptoms and pain persist for more than 4-8 weeks, you could have chronic sciatica. The duration of this more involved sciatica is highly variable.
How is sciatica diagnosed?
If you have sciatica, certain behaviors will cause pain. So, when you’re with Dr. Trujillo, he may ask you to walk on your toes or heels. He may ask you to rise from a squatting position or lift your legs one at a time when lying down.
He can usually get a good idea of your sciatica from your physical exam and listening to descriptions of your pain. However, if the pain is severe or isn’t improving with other treatments, he may order imaging tests.
- X-ray — A spinal x-ray can show bone spurs that are pressing on nerves.
- MRI — An MRI produces detailed images of bone and soft tissues such as herniated discs.
- CT Scan — For a CT scan of your spine, a contrast dye is usually injected into your spinal canal before the scan is made. The dye circulates around the spinal cord and the spinal nerves, which appear white on the scan.
- Electromyography (EMG) — This measures the electrical impulses produced by the nerves and the responses of your muscles. This can confirm nerve compression.
What are the non-surgical treatment options for sciatica?
The majority of sciatica cases do not require surgery. Many cases respond to self-care measures. Beyond that, Dr. Trujillo can use various treatment options.
These are some things you can do on your own:
- Over-the-counter painkillers
- Cold packs — An ice pack placed on the painful area for up to 20 minutes several times daily.
- Hot packs — After two or three days of pain, apply heat to the painful areas. If the pain continues, alternate hot and cold.
- Walking stretches the legs and back.
- Light stretching exercises for the low back — Try to not bounce or jerk but hold stretches for at least 30 seconds.
These are treatment options we use for sciatica at Summit Healthcare Pain Clinic:
- Medications — Dr. Trujillo may prescribe these medications: anti-inflammatories, muscle relaxants, narcotics, tricyclic antidepressants, and anti-seizure medications.
- Physical therapy — When acute sciatica improves, physical therapy can help you strengthen the muscles supporting your back, improve your flexibility, and correct your posture.
- Steroid injections — Dr. Trujillo can place injections of corticosteroid medication into the area around the irritated sciatic nerve root. These injections can be very effective, and they can last for a number of months. They can only be given periodically, however, as overuse can lead to serious side effects.
How is sciatica surgery performed?
Surgery to address sciatica is rarely necessary. It is usually only necessary when the compressed sciatic nerve is causing weakness, loss of bowel or bladder control, or when the pain becomes chronic and basically unremitting and isn’t responding to treatments such as physical therapy.
These are decompression surgeries, such as micro discectomies. In these surgeries, entry is usually made through the back, and covering muscles and other tissues are moved to the side. This provides access to the back of the spine. A portion of the lamina on the back of the vertebra where the compression is occurring is removed to gain access to the spinal disc and the compressed sciatic nerve. If the disc is herniated, the bulging portion is removed. If bone spurs are the problem, they are removed to increase space for the compressed nerve.
Surgery for sciatica typically provides pain relief for 85-90 percent of patients.
How can I prevent sciatica?
While it’s not always possible to prevent an occurrence of sciatica, there are some ways to help protect your back and lessen your odds.
- Exercise regularly — Any exercise is good for your entire body. To keep your back strong, focus on your core muscles. The muscles in your abdomen and lower back are essential for proper posture and alignment, both keys to avoiding sciatica. Dr. Trujillo can provide you with a list of great exercises.
- Proper posture — Invest in a good chair for work. It should have lower back support, armrests, and a swivel base. If necessary, place a pillow or rolled-up towel in the small of your back. When sitting, try to keep your legs and hips level.
- Good mechanics — Lift items with your lower extremities, not your back. Move straight up and down, and keep your back straight, bending at your knees. Hold the load close to your body, and don’t lift and twist at the same time.
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Dr. Trujillo specializes in pain management options including lumbar radiculopathy. If you think lumbar radiculopathy may work for you, please call our office at 928-532-1605 to set up a consultation.
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