Sciatica

The largest peripheral nerve in the body, the sciatic nerve is made from the nerve roots in the lower portion of the spine (lumbar and sacral regions). It runs from the lower portion of the spinal cord, behind the hip joint and down the back of the thigh. The condition known as sciatica (or lumbar radiculopathy) simply means the sciatic nerve is inflamed, which affects the normal functions of this area of the body. Leg muscles may become weak, and patients may experience pain in the lower back and/or thighs continuing down the legs. Symptoms may include cramping or burning sensations in the thigh, shooting pains from the buttock down the leg, or tingling sensations in the legs. Additionally certain movements, such as squatting or coughing, may cause symptoms to intensify as they may place increased pressure on or around the nerve.

The most common cause of sciatica is a herniated spinal disc. Other conditions, such as spinal stenosis or spondylolisthesis, may also cause sciatica symptoms. Although sciatica can happen to just about anyone, it is extremely rare in younger people. The condition is most often is seen in people 30 to 50 years old, and may occur very suddenly following over-exertion or a back injury.

TREATMENT

Several other conditions may cause hip and thigh pain, so it is important to determine the true cause of symptoms prior to beginning treatment. Once the diagnosis is established, treatment first addresses the inflammation associated with sciatica. Often rest, anti-inflammatory medications and muscle relaxers are prescribed. Patients who need a more powerful anti-inflammatory may be given oral steroids.

Physical therapy is often helpful, and indicated once the pain is under control. Heat and ice packs often help soothe painful muscles. An epidural steroid injection may be used to provide anti-inflammatory medication directly to the inflamed area.

Surgery is usually not indicated, but may be considered if, after three months, symptoms are not relieved with the treatments noted above. The surgical procedure may remove the ruptured disc, open up the bone around the nerve, or a combination of both.

PROGNOSIS

Fortunately, in most cases the nerve damage is not permanent and about 80-90 percent of sciatica patients fully recover without surgery within three weeks to three months. While sciatica is not a medical emergency, a sometimes-related condition called cauda equina syndrome is. If you experience difficulty with bowel or bladder function, decreased sensation around the genitals or progressive leg weakness, please contact your doctor or go to an emergency room immediately.

Lumbar Radiculopathy (Sciatica)