Sciatica (Lumbar or Sacral Radiculopathy)

Sciatica is a common form of back pain that radiates along the sciatic nerve. The sciatic nerve is the largest nerve in the body. Irritation of any of the nerve roots that contribute to it can lead to back pain that travels through the buttock and into the lower extremity.  

Sciatica can be caused by various degenerative changes of the spine, including a herniated disc, spinal stenosis, arthritic changes of the lumbar facet joints, and previous surgeries with formation of scar tissue around nerve roots. The primary cause of sciatica (present in about 90 percent of cases) is spinal disc herniation pressing on one of the lumbar or sacral nerve roots.

Sciatica itself actually refers to a symptom rather than a specific disease. The symptom is likely caused by a lumbar or sacral radiculopathy secondary to degenerative disc disease.

Symptoms

Typical symptoms include:

  • Pain in the lower back that travels to your buttocks and down the back of your thigh to your calf

Diagnosis

To diagnose your condition, we will take a medical history and conduct a medical exam. Based on our findings, we may use the following diagnostic tools:

  • Imaging, such as X-rays, CT scans or an MRI 
  • EMG (nerve study) is sometimes ordered if there is concern for nerve health with prolonged symptoms

Treatment

Non-surgical

  • Physical activity

Improving core strength and exercise can help with the musculoskeletal pain associated with nerve irritation. Often, a protruding disc that is causing sciatica resolves itself in a few weeks.

  • Medications that decrease nerve irritation can be tried.

Interventional
If non-surgical treatments are not effective, spine injection therapy such as epidural steroids may decrease inflammation around nerves that have been affected. Sometimes patients have a prolonged benefit from these interventions and oftentimes these are repeated. 

Surgical Treatments
If non-surgical treatments do not work or if the condition worsens, surgical conditions may be considered. The surgical treatment is individualized to the patient—and the underlying cause of their sciatica—and could include:

  • Discectomy
  • Surgical decompression and/or
  • Spine fusion

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