What is Sciatica?
Sciatica is a combination of pain, numbness, tingling, and weakness that travels from the lower back through the buttocks and down the leg. Technically speaking, sciatica is a symptom, rather than a disorder or disease. Much like a fever can be caused by a multitude of factors, sciatica has many different potential causes.
The sciatic nerve is the largest single nerve in the body and is composed of individual nerve roots that branch out from the spine in the lower back. Sciatica occurs when something pinches or irritates one of these spinal nerve roots in the lower back. The combination of pressure and inflammation can cause pain to radiate down the sciatic nerve, and when severe may represent nerve damage.
Causes of Sciatica
Herniated disc: The inner core (nucleus pulposus) of a disc can poke through the outer lining (annulus fibrosus) and put pressure on the spinal nerves. Herniated discs can be caused by a sudden twisting motion, injury, or repetitive stress.
Spinal stenosis: Narrowing of the spinal canal from enlarged facet joints (the joints that link vertebrae together), overgrowth of soft tissue, or a bulging disc (the disc slips out of the space between the vertebrae) can compress the spinal nerve roots as they exit the spinal canal. Spinal stenosis has a gradual onset and is a degenerative condition in an aging spine.
Degenerated disc: A weakened disc releases inflammatory proteins that can irritate the sciatic nerve.
Synovial Cyst: As the facet joints degenerate, the facet joint capsule can weaken and allow the synovial fluid that lubricates the joint to balloon out and put pressure on the spinal nerves.
Irritation of the sacroiliac joint: The joint at the base of the spine and pelvis can become inflamed and irritate the sciatic nerve.
The symptoms of sciatica include:
Pain on one or both sides of the lower body that runs from the lower back down through the back of the thigh and the leg
Pain that increases while sitting or standing up
Burning, tingling, weakness, or numbness in the leg
Difficulty moving the leg or foot
Non-surgical treatments for sciatica include physical therapy, NSAIDS, and oral or epidural steroids. However if the sciatic pain is severe and does not resolve with non-surgical treatments, spine surgery may be necessary. Surgical treatments aim to remove bone or soft tissue (disc/synovial cyst) that is irritating the nerve root to relieve pressure and decrease inflammation.
A lumbar laminectomy is used to remove a small portion of the lamina (bone) over the nerve root. A microdiscectomy is used to treat disc herniation by removing a small portion of the problematic disc.
Both laminectomies and discectomies can be performed using “open” or minimally invasive surgical techniques.
Open laminectomies or discectomies involve a large incision and require surgeons to strip the muscles away from the spinal column in order to locate the affected area. Some Patients may be candidates for minimally invasive spine surgery.
Minimally invasive discectomy is the preferred form of surgical treatment for sciatica by many surgeons and patients alike, as this procedure is often viewed as safer, more precise, and requires less recovery time than open procedures.