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What Is Sciatica and How Does It Affect You?
Sciatica’s searing, shooting nerve agony may take your breath away. Sciatica is a condition in which low back pain extends down the buttocks and the leg. Even though sciatica is quite widespread, affecting up to 40% of individuals, there are numerous misunderstandings about what it is.
Sciatica is a broad term for the pain that happens when nerve roots in the lumbosacral spine (low back) become compressed (pinched), irritated, or inflamed, usually as a result of a herniated disc or other constriction of the spinal canal (called stenosis). Numbness/tingling and muscular weakness are common symptoms of sciatica.
Suppose you’re experiencing pain in your lower back. In that case, you may have “sciatica,” a condition that stems from nerve roots in your spine, says orthopedic surgeon Jeffrey Wong, MD, who serves as Chief of the Orthopedic Spine Service and Co-Director of the University of Southern Colorado Spine Center in LA. According to him, the sciatic nerve is activated by nerve irritation or compression, which produces pain and other symptoms down the leg along the route of the damaged nerve.
Sciatica isn’t the only cause of discomfort in the buttocks or down the leg. The distress in most instances of sciatica spreads beyond the knee. True sciatica is caused by the pinched or inflamed nerve, although sciatica-like symptoms might be caused by joint or muscle disorders. It’s crucial to work with your doctor to figure out what’s causing your sciatica so you can get the best therapy possible.
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What Is the Sciatic Nerve and What Does It Do?
The sciatic nerve is the body’s longest and biggest nerve, measuring roughly three-quarters of an inch in diameter. The sacral plexus, a network of nerves in the lower back, begins (lumbosacral spine). The lumbar spine (limbo) and sacrum (sacral) are joined at the base of the spine, just above the tailbone, to form the lumbosacral spine (coccyx).
The sciatic nerve leaves the sacrum (pelvic region) via the sciatic foramen, a neural canal. The articular and muscular branches emerge from the top section of the sciatic nerve. The hip joint is served by the articular branch (articular means related to a joint). The muscular branch serves the leg muscles.
The sciatic nerve is divided into multiple smaller nerves that branch out from it. The peroneal and tibial nerves provide movement and sensation in the thighs, knees, calves, ankles, feet, and toes (motor and sensory functions).
What Are the Symptoms of Sciatica?
Sciatica is the most prevalent symptom of lumbar radiculopathy, a disorder characterized by pain, numbness or tingling, muscular weakness, or impaired reflexes along a nerve’s route.
Radiculopathy is when a nerve root is irritated or injured, resulting in pain and other symptoms radiating from the damaged nerve root. Sciatica pain is often experienced as low back discomfort that travels down the leg.
The most common sign of sciatica is pain. Although sciatica symptoms may occur anywhere along the sciatic nerve, typical sciatica extends from the low back into the buttocks and down the leg to just below the knee. If you experience low back discomfort, your doctor would most likely examine for sciatica.
Sciatica pain is less frequent. However, it may originate in the buttocks or hip region and spread down the leg.
The pain of sciatica is often characterized as electric, searing, or acute. The discomfort may range from moderate to severe, and it might become worse if you bend down, twist your back or cough.
Although you have two sciatic nerves (one on each side of your body), sciatica symptoms usually only affect one side. If you experience pain extending down both legs, it’s less probable that a pinched sciatic nerve causes the discomfort.
If the sciatic nerve is compressed, the muscles it serves may become weak, in addition to the discomfort. Bending your knee, bringing your thighs together (adduction), and pointing your foot and/or toes upward or downward might be difficult.
What Are the Causes of Sciatica?
Anything that compresses or pinches the sciatic nerve (especially where it leaves the spine) might induce sciatica. The following are a few of the most common:
Herniated discs: In the lower back, the elastic disc between the vertebrae may bulge or herniate, irritating and/or compressing the sciatic nerve roots. Sciatica is most often caused by a herniated or bulging disc.
Degenerative disc disease: As people become older, their spinal discs may begin to wear down. The gap between the vertebra gets squeezed if the discs become too thin, placing pressure on the sciatic nerve root. Fluid from the disc may seep out and irritate the sciatic nerve if the outer coating of the discs wears away.
Osteophytes (overgrowth of bone) on the vertebrae might place strain on the sciatic nerve roots. Osteoarthritis causes these bone spurs to grow around the vertebrae.
Spinal stenosis: Spinal stenosis is a spinal cord compression and sciatic nerve roots caused by a narrowing of the space through which they pass. Arthritis or age may be to blame for the narrowing.
Spondylolisthesis: For stability, the vertebrae are built to stack one on top of the other. Spondylolisthesis occurs when one vertebra in the lower back slides forward over the vertebra below it, putting pressure on the sciatic nerve.
Vertebral fracture: If the section of the vertebra that forms a joint (pars interarticularis) cracks or fractures, a condition known as spondylolysis, the sciatic nerve may be squeezed.
Piriformis syndrome: The piriformis muscle runs on top of the sciatic nerve in the buttocks, and if it gets excessively tight, it may compress the nerve. The symptoms may worsen after sitting for a long period, going upstairs, walking, or jogging. The piriformis muscle travels from the sacrum (the triangle bone under your spine) to the top of the thigh bone at the hip joint.
Other illnesses might mirror sciatica symptoms but are not caused by sciatic nerve impingement. Sacroiliac joint dysfunction, for example, is a pelvic joint condition that produces discomfort in the buttocks that may radiate down into the upper thigh.
The radiating sensations of sciatica might be masked by a tight iliotibial band (the tendon that spans the length of your outer thigh) or hamstring muscle. Furthermore, tension on the spine from pregnancy might induce radiating back pain, which is not often sciatica in the traditional sense.
It’s less likely to be sciatica if radiating pain remains in the buttock region and doesn’t move down the leg or just travels halfway down the thigh.
Sciatica is commonly confused with cauda equina syndrome, caused by a herniated disc pushing on the cauda equina nerve roots near the end of the spine. Cauda equina syndrome may cause bowel or bladder incontinence, in addition to radiating pain and paralysis. Cauda equina syndrome is a medical emergency that might result in long-term complications. If you’re experiencing symptoms, see your doctor immediately away.
What Is the Procedure for Diagnosing Sciatica?
While looking for the origin of sciatica symptoms, spine experts typically start with the spine since the most frequent cause of sciatica is pinching or compression of the sciatic nerve roots in the spine, most often due to a herniated disc.
Your doctor will take a medical history and ask questions about how the symptoms improve or worsen, as well as where the symptoms occur. Then, during a physical examination, your doctor will determine which motions aggravate your symptoms and assess muscular strength, sensitivity, and reflexes.
We start to assume that the reason is probably a pinched nerve, and we can identify the cause to a particular nerve root if there is a deficit and the symptoms are consistent with the same nerve root.
A straight leg raise test is a procedure in which you lie face up on a table, and your doctor progressively raises one leg to examine whether it aggravates your symptoms and when they begin.
Because this examination stretches the sciatic nerve, any pinching will result in sciatica symptoms. If your symptoms worsen when you bend in a specific manner or alter the posture of your spine, it’s a clue that your sciatica is originating from your spine.
Your doctor will most likely request an imaging scan to confirm the diagnosis. X- rays would reveal any bone issues, while an MRI would determine the exact location of the nerve compression.
What Are Some Nonsurgical Treatments for Sciatica?
Most individuals with sciatica or lumbar radiculopathy get better with time and react well to nonsurgical therapies, including medication, exercise, particular sciatica stretches, and physical therapy (PT).
Chiropractic therapy, for example, may also assist in alleviating sciatica discomfort. Sciatica usually improves after 4 to 6 weeks.
PT, exercise, avoiding activities that worsen symptoms, and OTC non-steroidal anti-inflammatory medicines (NSAIDs) are all standard therapy for sciatica. If it doesn’t help and the pain is severe, an epidural steroid injection or a nerve root block is generally the next step.
Before attempting steroid injections, a short course of oral steroids may be tried. When prescribed by a doctor or healthcare professional, over-the-counter (OTC) non-steroidal anti-inflammatory medicines (NSAIDs) may help decrease swelling and sciatic pain. OTC medications include acetaminophen (e.g., Tylenol), ibuprofen (e.g., Advil), and naproxen (e.g., Naprosyn) (eg, Aleve).
Are You a Candidate for Sciatica Surgery?
Most patients who suffer from sciatica or lumbar radiculopathy improve significantly with nonsurgical treatments such as medication, exercise and special sciatica stretches, and physical therapy.
If you have a decent quality of life and are still able to work and do the activities you want to do, there is no need to have surgery. However, surgery may be the best course of action if a patient comes into his office unable to sit, work, or care for their family.
Sciatica and lower back pain may sometimes be severe enough to necessitate surgery. Sciatica surgery is advised for people who have:
Abnormalities of the bowel and/or bladder (this is a symptom of the rare condition cauda equina syndrome)
Severe leg ailment
Nonsurgical sciatica therapy is inefficient or has ceased to be useful at relieving sciatica pain
Progressive deterioration of pain
Surgery may be quite beneficial in the proper candidate. In a small 2020 study published in the New England Journal of Medicine, patients with sciatica caused by a herniated disc who underwent surgery reported significantly less pain than those who underwent only physical therapy.
Additionally, medical recommendations note that discectomy for a herniated disc with radiculopathy (radiating pain) is considered to give more effective symptom alleviation than nonsurgical therapies such as physical therapy and steroid injections in individuals with severe symptoms.
Studies have shown that surgery may be quite beneficial in treating sciatica, particularly when there is genuine nerve compression, as caused by a herniated disc, spinal stenosis, disc degeneration, bone spurs, or spondylolisthesis. The source of sciatica determines the sort of surgery that is chosen.
Which Sciatica Surgery Do You Require?
The appropriate form of surgery is determined by the diagnosis, the number of spinal levels needing treatment, and the surgical objectives. In general, we strive to do the least feasible operation.
The majority of sciatica operations are spinal decompression surgeries, which are procedures performed by a spine surgeon to remove anything pushing on the sciatic nerve, such as a disc herniation. Certain people may need a combination of these procedures to alleviate sciatica pain.
Many patients have decompression surgery without being hospitalized at an outpatient or ambulatory spine facility. Additionally, a number of these operations may be accomplished using minimally invasive spine surgery (MISS)., MISS surgeons use specialized equipment and imaging technologies (such as miniature cameras) that enable them to operate via very small incisions.
The advantages of the minimally invasive method include reduced discomfort and a quicker recovery time after surgery, in part because less soft tissue is severed (e.g., ligaments, muscles). Additionally, this method is associated with a decreased risk of infection and reduced blood loss during surgery.
Minimally invasive surgery is an excellent alternative for people who have a single herniated disc or spinal stenosis. Patients who need surgery on many vertebrae or who require a more sophisticated procedure may benefit from standard open surgery.
If a herniated disc causes sciatica in the lumbar spine, which is one of the most prevalent causes of sciatica. A simple minimally invasive microdiscectomy is employed. Typically, micro discectomies provide excellent outcomes.
Microdiscectomy requires a tiny incision, is a quick procedure, and is often done in an outpatient environment. The surgeon either removes the complete disc or the disc section that compresses the nerve during either treatment (s). An artificial disc replacement may be used in certain circumstances to restore space and mobility between the vertebrae.
Laminotomy and Laminectomy are two terms that refer to the same procedure.
Laminotomy and Laminectomy are both procedures that are often used to treat spinal stenosis. They both entail the removal of a portion of the spine called the lamina—a thin bony plate that covers the spinal canal. The lamina is placed between two vertebrae in the rear or posterior spine. The difference between these operations is the quantity of lamina removed to access compressed spinal nerve roots caused by bone, disc, or other soft tissue.
Laminotomy is a procedure that includes the partial removal of the lamina.
Laminectomy is the complete amputation of the lamina.
The surgeon may reach the bulging or herniated disc in the posterior spine by partly or completely removing a lamina. Naturally, the surgeon may also remove more tissue (e.g., a bone spur) pushing on a spinal nerve root at a certain spinal level (e.g., L4-L5).
Foraminotomy enlarges the opening (referred to as a foramen) via which the spinal nerve root leaves the spinal canal. A tiny incision is made to remove bone fragments that are compressing the sciatic nerve root.
Interspinous spacers are small devices that are sometimes used to assist persons with spinal stenosis keep the spinal canal open and the nerves unpinched.
Fusion of the Spine
Spinal fusion of the vertebrae may be necessary for patients with spinal instability caused by spondylolisthesis or degenerative disc degeneration at various levels of the spine. This is a more involved procedure that aims to strengthen the spine and avoid uncomfortable motions. Spinal fusion involves the removal of the spinal discs in two or more vertebrae and fusing the vertebrae using bone grafts and/or metal implants screwed into place.
The good news is that sciatica often resolves with conservative treatments and that surgical options also have a high success rate. The most critical step is to see your physician to rule out any immediate concerns and determine sciatica’s underlying cause.
It’s past time to put an end to your sciatica. The first step is determining the precise cause of your sciatica to get the most effective therapy possible. Investigate six common sciatica causes in further detail. And, when you’re ready for a definitive diagnosis or therapy, locate a spine expert in your area who can assist you.
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