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Sciatica

Common cause of back & leg pain

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What Is Sciatic nerve?

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Sciatic nerve is the largest single nerve in the body, it starts in the lower spine & runs down the back of each leg. It controls the muscles of the back of the knee and lower leg. It also provides sensation to the back of the thigh, part of lower leg & the sole of the foot. It is the longest and widest single nerve in the human body, going from the top of the leg to the foot on the posterior aspect. It is derived from spinal nerve roots L4 through S3. 


What are the symptoms of Sciatica?

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Sciatica is a set of symptoms including pain caused by general compression or irritation of one of five spinal nerve roots (L4 to S3) of sciatic nerve.

Symptoms include: 

- Lower back pain

- Buttock pain, and numbness

- Pain or weakness in various parts of the leg and foot.

- "Pins and needles" sensation, or tingling in the leg


What are the common causes of Sciatica?

Spinal disc herniation

Herniated disc pressing on one of the lumbar or sacral nerve roots is the primary cause of sciatica, being present in about 90% of cases. 

Herniated Disc ➔

Spinal stenosis

This is a condition in which the spinal canal narrows and compresses the spinal cord or sciatic nerve roots. This narrowing can be caused by bone spurs, spondylolisthesis, inflammation, or herniated disc, which decreases available space for the spinal cord, thus pinching and irritating nerves from the spinal cord that travel to the sciatic nerves.

Anatomy of Spine ➔

Piriformis syndrome

In some people, the sciatic nerve runs through, or under the piriformis muscle. When the muscle shortens or spasms due to trauma or overuse, it causes compression of the sciatic nerve. Piriformis syndrome can cause sciatica when the nerve root is normal.

Pregnancy

Spinal Tumors

Trauma to spine such as car accident


How do you diagnose Sciatica?

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Medical history and physical examination can usually identify any serious conditions that may be causing the pain. Dr. Goswami will ask about the onset, site, and severity of the pain; duration of symptoms and any limitations in movement; and history of previous episodes or any health conditions that might be related to the pain. Along with the history, a thorough neurologic examination will be conducted to determine the cause of pain. 

Imaging tests are not warranted in most cases. Under certain circumstances, however, imaging may be ordered to rule out specific causes of pain, including herniated disc or spinal stenosis.

Commonly used diagnostic tests include:

  • X-ray

  • Computerized tomography (CT)

  • Magnetic resonance imaging (MRI) 

  • Myelograms 

  • Discography

  • Electromyography (EMG)/ Nerve Conduction Studies (NCS) 

  • Evoked Potential (EP) studies


How do you treat Sciatica?

The goal of our treatment is functional restoration. While eliminating chronic back pain is extremely hard, our functional restoration program seeks to return patients to levels of activity that they were able to perform prior to suffering from back pain. Usually a combination of conservative therapy, physical therapy and interventional therapy is needed. 

Conservative treatment 

  • Applying heat or ice to the painful area
  • Taking over the counter pain relievers such as Tylenol or Ibuprofen.  

Physical Therapy/ Muscle strengthening regimen

We encourage our patients to begin stretching exercises and resume normal daily activities as soon as possible, while avoiding movements that aggravate pain. Physical therapy programs to strengthen core muscle groups that support the low back, improve mobility and flexibility, and promote proper positioning and posture are often used in combinations with other interventions.

Medical Management

We prescribe different medication for pain relief. Certain medication such as anticonvulsants and antidepressants are known to benefit patients suffering from sciatica. In some patients we also prescribe opioids such ascodeine, oxycodone, hydrocodone, and morphine. The use of opioids is heavily regulated by Drug Enforcement Agency (DEA). In our practice all patients who are being treated with opioids are required to sign an Opioid Agreement and periodically undergo urine and blood testing.

Minimally Invasive Treatment

Some of the common minimally invasive treatment options include:

Epidural Steroid Injection

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A small amount of corticosteroid is injected into the epidural space around the spinal cord and spinal nerves. The anti-inflammatory effects of the corticosteroid is responsible for providing pain relief. 

Endoscopic Discectomy

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A small metal tube, the size of a pencil, is inserted into the herniated disc space under x-ray and camera guidance and the fragment of the disc pinching the nerve is removed. You might benefit from discectomy if your presentation includes: pain, numbness or weakness in arms or legs.


Will I need open surgery?

Open surgery is usually reserved for very few patients with pain from structural anatomical problems that have not responded to medical or interventional therapy.