Sciatica is a term often used generally by patients to describe pain or symptoms down the leg. Medically speaking, sciatica describes pain, paresthesias and/or weakness radiating down a leg following a specific pathway, from the back into the gluteal region and down the side or the back of the leg and into the foot and large toe or under the sole of the foot. It is caused by damage, pressure, swelling or inflammation of the sciatic nerve which is made up of our L4, L5, S1 and S2 nerve roots at the end of the spine.
Sciatica is a description of symptoms occurring from inflammation, pressure or injury to the sciatic nerve. This can be as a result of, a bulging or herniated disc, degenerative disc disease resulting in stenosis, or changes in the vertebra alignment as occurs with a spondylolisthesis or slippage of one vertebra on another. Less commonly it can be caused by infection or a spinal tumor.
Your physician may request and x-ray of your lumbar spine to check the alignment and disc height to begin with. Further detail of herniated or bulging discs, stenosis or any soft tissue decline is more readily seen on an MRI or magnetic resonance imaging. He/she may also request a nerve test or EMG (electromyography), which will identify if the muscle has lost it nerve response. This test can also help to identify if there is permanent damage to the nerve.
If the sciatica is caused predominantly by irritation and inflammation and not severe compression, then physical therapy, chiropractic’s and interventional procedures such as epidural shots can reduce the inflammation and the symptoms will resolve. Management such as good posture and body mechanics, strengthening core muscles and maintaining spinal flexibility can prevent it from reoccurring.
If there is compression from a disc herniation, osteophytes, stenosis or mal- alignment of the spine, surgery may be recommended. Depending on the severity of the pathology surgery may only need to be a minimally invasive procedure such as a laminotomy or microdisectomy to free the nerve or it may require more complex surgery that clears the area around the nerve and maintains this space with a cage or rods and screws as used for a spinal fusion. Your physician will review and discuss your problems and help you to choose the best option for you.
Conservative care of sciatica can be very effective in managing and controlling it. If the cause is from compressive forces such as a herniated disc, stenosis etc., then surgery can be very effective but the surgical risk of failure, infection or further joint deterioration can still occur.
Sciatica is the result of nerve irritation or joint injury or damage that compromises the nerve. We can prevent joint damage with good posture, correct body mechanics, avoiding heavy lifting, repetitive motion and limiting sitting and sustained postures. Healthy exercise, core stability, joint flexibility and avoiding becoming overweight will all help to prevent the inflammation and/or joint damage that leads to sciatica. Surgery cannot be prevented if there is compression of the nerve or loss of joint space but at this point, surgery can bring relief. Our goal is to avoid surgery until it is absolutely necessary.
If you are tired of living and in pain with limited mobility due to sciatica or any other spinal issue, contact Comprehensive Spine Institute today! We would be happy to run tests and implement a treatment plan to get your symptoms under control, so that you may live a pain free life.
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