One of the more common complaints evaluated by health care providers on a daily basis is Sciatica which is described generally as pain in the lower back or buttock that radiates into the leg and the foot along the path of the sciatic nerve. Patients will sometimes complain of associated numbness, tingling and even weakness in their lower leg with difficulty sitting. Symptoms can appear suddenly or gradually, and with or without a preceding precipitating event such as lifting or other back straining activities.
Sciatica occurs by irritation or compression of the nerve roots in the lumbar spine or direct irritation of the sciatic nerve itself. The more common causes are muscle strain in the lower back and buttocks generating spasm, or degenerative conditions such as bulging or herniated disc, spinal stenosis or degenerative disc disease, all of which can irritate and compress the lumbar nerve roots comprising the sciatic nerve. Less often, the sciatic nerve can be affected by compression at the hip, buttock or thigh generating similar symptoms often described as piriformis syndrome.
Sciatica is self –limiting in many patients, in that some patients will begin a course of anti-inflammatories on their own along with rest, stretching, ice or heat, and symptoms will improve or disappear. However, patients with persistent symptoms, especially those with severe pain associated with radiating lower extremity numbness, tingling, weakness and bowel or bladder dysfunction, should seek guidance from their health care provider.
In general, a physical exam and baseline x-ray of the lumbar spine should be performed to rule out obvious anatomic abnormalities contributing to sciatica. Sciatica can be treated successfully in most patients with anti-inflammatories, muscle relaxers, and physical therapy. At times, a provider may want to perform an MRI of the lumbar spine to take a closer look at possible causes for the sciatica, especially if more aggressive treatment options are needed. This study helps to define what if any of the nerve irritation may be emanating from compression or narrowing of the nerves and can help facilitate further treatment options.
In patients who do not respond to initial conservative treatment, sometimes an epidural steroid injection will be indicated. This is an X-ray guided steroid injection into the area where the nerve irritation is located. It is designed to decrease the inflammation associated with the nerves and can be successful for pain relief, provided there is no critical compression on the nerves on the MRI. In instances where nerve compression is a concern, and conservative management has failed, a surgical opinion is needed.
Jeffrey D. Wade, MD is an orthopedic surgeon in practice with Summit Orthopedics, Spine & Sports Medicine.
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