What Is Sciatic nerve?
What are the symptoms of Sciatica?
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.
- 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.
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.
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.
Trauma to spine such as car accident
How do you diagnose Sciatica?
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:
Computerized tomography (CT)
Magnetic resonance imaging (MRI)
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.
- 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.
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
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.