Some Nerve: Understanding Sciatica

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By Hesham Saleh, MD

Do you have shooting pain in your leg? Numbness in the back of your calf or tingling in your foot?

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Your symptoms  — commonly referred to as sciatica — may be caused by injury or pressure on your spinal nerves.

If sciatica is keeping you from being able to do things you love and affecting your quality of life, treatment is available.

The Penn Medicine Princeton Medical Center for Spine Care provides high quality, comprehensive, individualized care, for patients experiencing spine and spine-related conditions, including sciatica. The Center brings together all aspects of diagnosis, treatment, surgery, rehabilitation and wellness to minimize pain and improve function.

About Sciatica

Unbeknownst to many, sciatica is not a medical condition in and of itself but is a term to describe shooting pain, tingling or numbness anywhere down the leg into the foot. The medical term is lumbar radiculopathy.

Sciatica occurs when there is irritation of one or more of the spinal nerves that start in the lumbar spine, your lower back, and travel toward your legs.  Each spinal nerve controls a particular muscle group and area of sensation.

Sciatica typically affects people in middle age, and up to 40% of people in the United States will experience sciatica at some point in their lives, according to the National Institutes of Health.

Causes

One of the most common causes of sciatica is a herniated disc in the lower part of your spine.

Your spine is composed of 33 bones called vertebrae. In between those bones are discs made up of jelly-like substances that act as cushions for your spine.

A herniated disc occurs when part of the disc squeezes through a weakened part in the spine, which can put pressure on the surrounding nerves.  Herniated discs are often caused by lifting a heavy object too fast or without proper form.

A herniated disc may cause compression of one of the spinal nerves, which causes irritation, and this irritation is what causes sciatica.

Another common cause of sciatica is stenosis, which means compression of the spinal canal. Compression in the canal sometimes occurs as a consequence of arthritis, where bone spurs and thickened ligaments put pressure on the nerves as they are exiting the canal.

As with a herniated disc, this would cause irritation of the spinal nerves and sciatica.

Symptoms

Sciatic pain can vary from person to person and range from mild to severe.

Many people report a burning pain or electric shock sensation that shoots or radiates down the leg. The pain may be felt anywhere in the legs — from buttocks to the feet — depending on what nerve is irritated. Sometimes patients describe feelings of pain, cramping, or heaviness when walking longer distances.

In some cases, the pain may present as a dull ache or a tingling sensation. In others, people may experience numbness or weakness in the affected leg. Some patients describe their foot getting caught on the ground when walking, a sign of muscle weakness.

Most of the time, the pain occurs on one side or the other. It may get worse:

  • After standing or sitting
  • During certain times of the day, such as at night
  • When sneezing, coughing or laughing, especially if caused by a herniated disc
  • When bending backward or walking more than a few yards or meters, especially if caused by arthritis

If you have sciatica, don’t ignore it. The longer the nerve is compressed, the greater risk for permanent damage.

Diagnosis and Treatment

Physicians can often diagnose the cause of sciatica by talking with patients about their symptoms and through a physical exam to check for weakness or numbness in the leg and foot.

Imaging tests such as an X-ray and MRI, magnetic resonance imaging, may be recommended. An X-ray detects arthritis or signs of instability, while an MRI shows the nerves, disc herniations, or any other causes of nerve compression. An MRI is considered the gold standard in determining the root of sciatic pain.

The vast majority of patients with sciatica are treated conservatively, meaning that they do not need surgery. Once diagnosed, sciatica can typically be treated with anti-inflammatory medications and physical therapy to help stretch and strengthen the lower back.

If the pain continues, an epidural steroid injection around the nerve root can often calm down the irritation and reduce symptoms. Steroid injections are often administered every three months until the condition resolves.

In some instances, when conservative measures do not help or there is significant weakness, surgery may be recommended to relieve compression on the nerve. There are two main types of decompression surgery, a microdiscectomy and a laminectomy.

  • A microdiscectomy is the surgical removal of the herniated disc that is compressing the nerve. The remainder of the normal disc is untouched.
  • A laminectomy is the surgical removal of bone spurs, thickened ligaments, and any other bony or soft tissues that are pressing on the nerve.

Surgeons at the Penn Medicine Princeton Medical Center Spine Center perform both microdiscectomy and laminectomy using a minimally invasive approach, which typically results in less pain and faster recovery after surgery. Both surgeries are performed through a small incision in the lower back. Most patients go home the same day or the next morning.

If you are experiencing sciatic pain, see your doctor. With appropriate treatment, you can recover and restore your quality of life.

To find a physician affiliated with Penn Medicine Princeton Health, call 1 (888) 742-7496, or visit princetonhcs.org.

Hesham Saleh, MD, specializes in spine surgery and is a member of the Medical Staff at Penn Medicine Princeton Health.

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