Sciatica is a painful condition that affects the lower back and the leg. When the sciatic nerve becomes irritated, sciatica leads to pain that is typically felt on just one side of the body. Besides discomfort, sciatica is known to cause numbness in the affected regions of the body, as well as trouble with controlling the leg.
When a person has sciatica, pain radiates from the lower back down to the thigh, extending downward to the back of the calf. In some cases, pain from sciatica flows upward as well, affecting the hip, and back down toward the foot. For many affected individuals, pain from sciatica is enough to impair the performance of everyday tasks.
Anatomy of Sciatica
As the largest nerve in the human body, the sciatic nerve has great range, extending from the lumbar spinal cord down through the leg.
Anatomy of the Formation of the Sciatic Nerve
The sciatic nerve is formed from the L5 and S1 nerve roots in the spinal canal and the union of these nerves becomes the sciatic nerve in the pelvis. The sciatic nerve continues through the pelvis into the buttock and back of the upper thigh to the back of the knee where it splits into nerves coursing into the calf.
Causes of Sciatica
The most common of the causes of sciatica inflammation involves a herniated disc. It is important to understand here that each vertebral disc in the back is made up of a very tough outer layer of cartilage and a more elastic central area.
As the age increases, these disks end up degenerating and becoming much thinner and weaker over time. Especially when you are putting a lot of pressure on this area for extended periods of time, this can result in causing cracks in the outer layers of the disks, thereby allowing the central mass to squeeze out.
The bottom line is that one of the main causes of sciatica inflammation then is herniated discs in the lumber or sacral regions which put pressure on the sciatic nerve and result in causing pain and discomfort.
Signs and Symptoms of Sciatica
Mild to intense pain in the buttock, thigh, calf or foot, or in all these areas is experienced.
If the pressure is more on the nerve, numbness will also be felt.
The numbness, however, is not always accompanied by back pain and this can lead to sciatica being mistaken for a pulled muscle.
If one experiences numbness, a feeling of pins and needles and loss of bladder control along with sciatica, the nerve pressure could be bad enough to cause permanent damage. This requires immediate medical attention.
Diagnosis of Sciatica
The diagnosis of sciatica is based on history taking and physical examination. The investigation will help to pinpoint the irritated sciatic nerve. The physician will then carefully consider the results of the questions and physical investigation and may then decide that special tests are necessary.
you may be subjected to one or more of the following : -
Imaging is indicated only in patients with "red flag" conditions or in whom disc surgery is considered
MRI (Magnetic Resonance Imaging)
CAT (Computerized Axial Tomography) or CT (Computerized Tomography) scan:
Spinal X-Ray: this special type of X-Ray procedure does not show the normal causes of sciatica, but can be used to highlight tumours that might be irritating your sciatic nerve
The main reason for these tests is to find out precisely what is causing your sciatica (if it is not already obvious), and whether an operation will help to cure it. Note that there are other tests being devised all the time, such as Needle Electromyography and Nerve Conduction Studies.
Treatment of Sciatica
Non Surgical Treatment
Conservative Treatment Of Sciatica
Instruction for The Sciatica Patients : -
Being aware of and avoiding activities or bodily movements that trigger or aggravate sciatica.
Although sciatica is painful, some activity is better than none. Avoiding prolonged bed rest. Inactivity can make symptoms worse. A day or two of rest may be helpful, but avoid the temptation to lay in bed doing nothing else for a week.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are helpful to reduce inflammation and sciatic nerve pain. NSAIDs include aspirin and ibuprofen.
Acute or chronic sciatic nerve pain may require more aggressive types of non-surgical treatment. The doctor may combine therapies for maximum back and leg pain relief.
Medication for Sciatica
If pain is severe, the doctor may prescribe a more potent NSAID. Chronic sciatica may require a muscle relaxant and/or anti-depressant medication. Certain anti-seizure and anti-depressant medications are effective in blocking pain messages sent to the brain. Some of these drugs may enhance the body's production of natural pain killers - endorphins.
Epidural Steroid Injection for Sciatica
This type of spinal injection places a steroid (corticosteroid) medication near spinal nerve roots. Steroids reduce inflammation and can help to ease back and leg pain. An epidural steroid injection may provide pain relief for several months or longer.
Therapeutic exercise helps the patient to increase flexibility, spinal range of motion, and build a stronger body. Patients are urged to continue a regular flexibility and strengthening program at-home
Surgical Treatment of Sciatica
If the healthcare professional's diagnosis of your condition is that you have sciatica, they may then, if your condition is severe enough, decide that surgery is appropriate.
Traditional surgical procedures are always elective (ie it's up to you whether to try them);
the common procedures are : -
Discectomy : - All or part of the problem disc is removed. Read More.
Laminectomy/Laminotomy : -All or part of the lamina (part of the bony vertebra) is removed to relieve pressure on the sciatic nerve. Read More.
Surgery does not necessarily mean being cut open; there are some minimally-invasive procedures becoming available,
such as : -
Intradiscal Eletrothermoplasty : - A heated wire is inserted into the problem disc through a needle and used to destroy the tiny nerve fibres causing the sciatica.
Radiofrequency Discal Nucleoplasty : - A radio frequency probe is inserted into the problem disc through a needle and highly-focused radio frequency field is used to vapourise some of the disc, reducing its size and thereby decompressing the disc to reduce the pressure on the sciatic nerve.
The list of of world class Spine hospitals in India is as follows : -
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When a person has sciatica, pain radiates from the lower back down to the thigh, extending downward to the back of the calf. In some cases, pain from sciatica flows upward as well, affecting the hip, and back down toward the foot. For many affected individuals, pain from sciatica is enough to impair the performance of everyday tasks.
