What is Sciatica?

Sciatica is defined as pain or other symptoms that radiate from the spine down the leg. These symptoms follow the path of the sciatic nerve, from which sciatica gets its name. The sciatic nerve is the longest and largest nerve in your body and runs from the spine, through the buttocks, and down the back of your legs.

The sciatic nerve is formed from 5 nerve roots that exit from the spinal cord. Two of these founding nerve roots come from the lumbar spinal cord (your lower back), and the other three come from the sacrum (your pelvis).

What Causes Sciatic Nerve Pain?

The sciatic nerve can cause pain or discomfort by being compressed or irritated. People experiencing symptoms of sciatic nerve irritation are said to have ‘sciatica’. Inflammation of tissues surrounding the sciatic nerve, or even tissues that encroach upon the nerve roots that form the sciatic nerve, can lead to sciatica—and as many as 37% of adults will experience sciatica at some point in their lives.¹

How is Sciatica Diagnosed?

The sciatic nerve splits into branches around the knees with resulting nerves supporting sensation and movement to the outer part of the foot and leg, the calf of your leg, and the sole and heel of your foot. As a result, doctors can sometimes determine which nerve root may be compromised by reviewing the symptoms you are experiencing. Your surgeon may observe you as you walk or perform a “straight leg raise” test to determine which nerve has been impacted.

Additional imaging tests are often performed, such as X-rays, MRIs, CT scans, or EMGs, to better pinpoint the location of sciatic nerve irritation.

What Does Sciatica Feel Like?

Sciatica symptoms can often travel down the sciatic nerve and be described as a “shooting” pain. The strength of symptoms can vary depending upon the nature and degree of nerve irritation and can range from mild to severe. Some patients describe sciatica symptoms as painful, and others as tingling or electrical in nature. Severe cases can lead to muscle weakness, instability, or even bowel or bladder changes.

How Can Sciatica Pain be Relieved?

Since sciatica is caused by nerve irritation, often due to inflammation of surrounding tissue, most sources of relief focus on removing the cause of the irritation. Mild cases of sciatica can be treated with non- surgical treatments, such as:

Ice and/or Heat
- Most providers begin with a cold treatment for several days to reduce inflammation before beginning with alternating heat and cold.
- Either heat or cold (or alternating both) may work better– trial and error may help determine the best approach.
Non-Steroidal-Anti-Inflammatory Drugs (NSAIDs)
- This is a class of pain relievers that are over-the-counter and are intended to aid in reducing inflammation.
Exercise/Stretching
- Knowledgeable instructors can provide targeted activities that may help reduce swelling.
- This is often undertaken after some inflammation has been reduced by ice/heat or
  NSAIDs.

If the above techniques are not effective in reducing sciatica symptoms, the guidance of a healthcare professional should be obtained. They may propose one or more of the below options:

Prescription medications
- Painkillers, muscle relaxers, and other medications may relieve the symptoms of sciatica and require a physician’s approval for use.
Physical therapy
- Guided training in physical movements, such as stretches, that may aid in reducing inflammation by improving circulation and other means.
Spinal injections
- Injections of drugs into the spine, such as steroids, that may relieve symptoms causing sciatica.
Alternative therapies
- Acupuncture, chiropractic care, massage therapy, and other therapies with a variety of approaches to potentially reduce inflammation, or symptoms associated with sciatica.

How is Sciatica Treated Surgically?

If none of the above non-surgical treatments are effective, then your healthcare provider may redirect you to a surgeon. Surgical options may include:

Discectomy
- Removal of disc herniation and material that can impinge upon the nerve roots that form the sciatic nerve.
Laminectomy
- Removes bone (the lamina) that can form bone spurs or otherwise impinge upon the exiting nerve roots that form the sciatic nerve.
Total disc replacement
- This procedure replaces an entire disc with an artificial implant that is designed to enable motion within the spine.
Spinal fusion
- This procedure replaces an entire disc with an implant or bone graft material to fuse and immobilize a segment of the spine.

When Should You See a Doctor About Sciatica?

Severe sciatica should always be treated by a healthcare provider. Severe cases can include a sudden onset from trauma (like a car crash) or sciatica that causes muscle weakness. Bowel and bladder issues are also considered severe and should be reviewed by a physician.

About the Author:

Dr. Zachary Goldstein is primarily focused on minimally-invasive and outpatient spine surgery. As a specialist, his goal is to provide his patients with all of the latest information and insight needed to understand their condition, the treatment options available, and then together decide the best option for them. Whether pursuing conservative, non-surgical measures, or the least invasive and most cutting-edge surgical procedure available, he wants his patients to feel confident and comfortable with the treatment plan.

¹ Cook CE, Taylor J, Wright A, Milosavljevic S, Goode A, Whitford M (June 2014). "Risk factors for first time incidence sciatica: a systematic review". Physiother Res Int. 19 (2): 65–78. doi 10.1002/pri.1572. PMID 24327326.

Opinions expressed herein are those of Dr. Goldstein based upon his qualifications as a surgeon.

Important Note: The patient information presented is for general education purposes only. As with any spine surgery, there are potential benefits, complications, and risks associated with disc replacement and spinal fusion procedures. Individual results may vary. It is important that you discuss the possible risks and potential benefits of various procedures with your doctor prior to receiving treatment, and that you rely on your physician’s best judgment. Only your doctor can determine whether you are a suitable candidate for a specific surgical procedure.

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