The sciatic nerve is a large cable of nerves formed by smaller nerve roots that merge together after exiting the lumbar spine (lower back). Within the sciatic nerve, electrical information travels back and forth between your spinal cord and your legs, allowing your brain to control leg muscles, and to receive sensory information from the joints, tissues, and skin of the legs.
The term “sciatica” refers to unpleasant sensations in the leg caused by pinching of one of the nerve roots in the lumbar spine (lower back) that make up the sciatic nerve. These sensations, such as numbness, tingling, or pain, are typically felt along the back and sides of the leg, often including the feet, along the pathway of the sciatic nerve. In severe cases, sciatica can be more than just pain and can include weakness of muscles in the leg.
Causes
The most common cause of sciatica is wear and tear (arthritis) of the joints and ligaments in the lumbar spine. As these arthritic joints become misshapen or lose their alignment, they can cause pressure on nearby nerves traveling within the spinal column, that make up the sciatic nerve.
Approximately 2-5% of the general population will experience sciatica at some point. However, certain individuals are at higher risk. Risk factors include advanced arthritis in the spine, family history, tobacco use, frequent trauma (collision sports), heavy labor, obesity, and a sedentary lifestyle.
Symptoms
Most cases of sciatica are not severe and are self-limited. Symptoms will usually resolve by 6 to 8 weeks. Unfortunately, patients who have experienced sciatica once are likely to experience symptoms again unless certain preventive measures are taken. Usually, this means eliminating risk factors such as obesity and tobacco use, engaging in routine and frequent core exercises, and observing proper postural techniques at all times.
Treatment
When treatment is required, it is crucially important to seek the help of experienced, qualified spine specialists who prioritize conservative care over surgical intervention. These specialists must understand the complexities of diagnosing sciatica, especially because very few of a patient’s sciatica complaints can be measured. Leg pain can have a great many causes, such as hip or knee arthritis, or muscle injuries that have nothing to do with the spine. To further complicate matters, sciatica can never be diagnosed by X-ray or MRI alone, because most adults, after the age of 35, have abnormal findings on MRI that are incidental, and do not cause symptoms (beware of doctors who provide remote MRI reviews).
A spine specialist evaluating your sciatica must be willing to spend a great deal of time listening to you in order to gather clues about where your pain is coming from. He or she must also ask a lot of questions:
- Where is the pain located and where does it travel?
- What type of pain is it?
- What brings on the pain?
- What positions make you feel better?
Finally, he or she must conduct a detailed physical and neurological examination that differentially focuses on the possible pain generators. It is only then that the spine specialist can determine whether your leg pain represents sciatica, from a pinched nerve in the spine, or from another source.
The primary reason that spine patients become dissatisfied by treatment results is not the quality of treatment, but rather the accuracy of the initial diagnosis. For instance, a patient may undergo well-executed discectomy surgery for a herniated disc but still have the same leg pain postoperatively. Why?
It is not because the surgery went badly. Rather, it is because the disc herniation seen on MRI was an incidental finding (remember, most adults have painless abnormalities on MRI), and was not responsible for their leg pain. An inflamed sacroiliac joint caused the leg pain instead, for instance, or piriformis muscle in spasm, or even a bone spur in the hip. In any event, the patient could have avoided unnecessary spine surgery if enough time had been taken to establish an accurate diagnosis prior to treatment. This initial step should never be rushed.
Once an accurate diagnosis has been made, appropriate treatment can be started. Up to 95% of sciatica patients will return to normal activity without surgery. The body has a remarkable capacity for healing, and the role of your spine specialist is to guide you through this process quickly and prevent future recurrences of symptoms.
For the rare patients who do need injections or surgery to regain normal function, the spine specialists must have a broad range of skills, from minimally invasive techniques to more extensive procedures, and a proven record of technical mastery, to assure optimal results. You owe it to yourself to get treated by the best spine specialists in the field.
NJ’s Most Comprehensive, Multidisciplinary Facility Recommended for Alleviating Sciatic Pain
The dedicated surgical and non-surgical team at Centers for Neurosurgery, Spine, and Orthopedics (CNSO) understands how neck, back, and sciatica problems can impact daily life. By working with leading board-certified neurosurgeons, orthopedic spine surgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists, patients will receive comprehensive and coordinated care, so they can resume a healthy, less painful lifestyle free from disability.
Centers for Neurosurgery, Spine & Orthopedics offers multiple convenient locations spanning across northern New Jersey, including Bergen, Passaic, Essex, Morris, and Hudson counties. Northern NJ patients can learn more about effectively treating sciatica pain by contacting the doctors at CNSO today.
