Sciatica is caused by irritation or compression (pinching) of the sciatic nerve or the lumbar spine nerves that feed in to merge together to form the sciatic nerve. Sciatica typically manifests as pain radiating from the buttock down the back of the thigh into the calf and/or foot. Oftentimes, sciatica is associated with numbness and tingling as well as pain into the same region of the back of the leg. Occasionally, patients may also have some associated weakness. Sciatica is often a form of radiculopathy (please see Radicular Syndrome for more details).
Most commonly, sciatica is due to ruptured/herniated disk in the lumbar spine (lower back). Other causes of pinching of the nerves causing sciatica include bone spurs in the spine, tumors of the nerves in the spine or the sciatic nerve itself. Occasionally thickened ligaments or bone overgrowth in the spine can irritate the nerves and cause sciatica. Rarely, sciatica can be caused by a direct trauma to the sciatic nerve in the leg or buttock.
MRI or CT Myelogram of the spine are usually the main forms of imaging applied to diagnose causes of sciatica. These studies will usually identify compressive etiologies in the spine, such as a disc herniation or lumbar spondylosis. Other testing might include electromyelogram (EMG) to identify damage to the sciatic nerve or one of its originating lumbar spine nerves. Physical finding and history by the physician alone can usually make the diagnosis of sciatica, but the cause usually requires further investigation or testing.
Oftentimes sciatica responds favorably to a combination of rest, oral medication such as analgesics, anti-inflammatory medications, muscle relaxants, physical therapy, chiropractic, or acupuncture treatment. Sometimes injections in the spine are required. If none of the above relieves the sciatica pain, surgery to relieve nerve compression in the spine enjoys a good success rate (85-95%) with a good likelihood of return to previous normal activities.
Most often, sciatica resolves with non-surgical treatment, but when surgery is required success for the relief of the sciatic pain and numbness is usually highly successful. Complication risks are rare but include persistent pain, infection, nerve damage and cerebrospinal fluid leakage.
For non-surgical information, please click here to learn more about Dr. Ghermay, Director of Dallas Back Pain Management.
Surgeries most often used to treat Sciatica include:
Laminectomy – click here to view a surgical animation
Micro Endoscopic Diskectomy – click here to view a surgical animation
TLIF – click here to view a surgical animation
ALIF – click here to view a surgical animation