Sciatica is leg pain that is associated with tingling, numbness and weakness. The symptoms often radiate from the lower back via the sciatic nerve that is located at the back of the leg. Sciatica most frequently results from compressions of spinal nerve roots (radiculopathy) rather than from lesions on the sciatic nerve itself. However, the pain travels through the sciatic nerve which is made up from several lumbar spinal nerves. It can also result from compressions of nerve plexuses in the pelvis. Thus, sciatica is not really a diagnosis but merely a lay description of the symptoms of pain localizing along the sciatic nerve. Conditions that can cause sciatica include spondylolisthesis, spinal stenosis, herniated discs, spinal and pelvic masses or tumors.
Sciatica results in periodic mild to severe debilitating pain along the large sciatic nerve. The effect varies based on the nerve root that is affected. Inflammation or herniations can irritate the nerve roots due to their increased sensitivity. This contributes to the severity of pain.
Non-operative treatments for sciatic pain include anti-Inflammatory medications such as NSAIDs or specific agents acting on neuropathic pain. These reduce swelling and pain. Physical therapy is very effective because it strengthens the muscles and improves structural support of the vertebrae. An epidural injection provides therapeutic effects in relieving pain caused by sciatica when this is caused by compressions of spinal nerve roots associated with inflammation. It is administered under live x-ray guidance. The substance injected consits of a corticosteroid that has potent anti-inflammatory effects. Benefits are seen after 1 injection but more may be necessary.
Spinal cord stimulation can effectively block severe chronic sciatic pain. Please visit out page on this advanced modality for additional information.
Surgical treatments are available for patients who continue to experience significant pain resulting from structural lesions that compress nerves and can be corrected. However, these procedures are associated with risks and complications such as nerve root injury, excessive scarring around the nerve root and mechanical instability. Surgeries include discectomy and laminotomy or excision of masses or lesions causing a neural compression.
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