Sciatica Treatment in New Jersey
THERE ARE VARYING DEGREES of unpleasantness capable of occurring in the condition known as sciatica. From a strange tingling to pain and muscle weakness, the sensations can have a noticeably debilitating effect on day-to-day activities as well as quality of life. At Centers for Neurosurgery, Spine, and Orthopedics, our team of doctors, surgeons, pain management specialists, physiatrists, and physical therapists, will tailor a treatment plan to resolve your sciatic pain.
What is Sciatica
Sciatica refers to any pain, numbness, tingling, or weakness that radiates down the leg along the path of the sciatic nerve. This large nerve transmits movement signals from your brain through your spine and into the gluteus muscles, hamstrings, and most of the muscles below the knee down into the foot. The sciatic nerve also allows sensory information (e.g., hot, cold, pain) from these regions to travel back to the spinal cord and into the brain.
The large sciatic nerve is made up of many smaller nerves that individually exit the lumbar spine in your lower back (lumbar spine). These smaller nerves merge together to form the sciatic nerve.
Sciatica symptoms usually result from pressure applied to one of these smaller nerves, causing the brain to feel discomfort downstream from the pinching. Therefore, sciatica is synonymous with a pinched nerve in the lumbar spine that causes radiculopathy on the same as the effected gluteus and leg.
Often, sciatica results from a herniated disc, slipped disc, or spinal stenosis. Consequently, treatment is similar to these other conditions, and normally resolves with NSAIDS, physical therapy or perhaps a steroid injection. Sciatica can more rarely be caused by compression of the sciatic nerve from a tumor on the spine, a tumor on the nerve, or from diseases that affect nerves such as diabetes or Lyme.
“Every Year, 3 Million Americans Suffer from Sciatic Nerve Pain.”
Symptoms of Sciatica
The most common symptom of sciatica is pain, which radiates from your low back, through the buttock, and down the back or outside of the leg. Symptoms are typically one-sided and can be mild to quite severe. The pain can radiate down the entire leg or be isolated to a smaller region along the nerve path and range from a constant dull ache, often described as a toothache in the leg, to a sharp, severe, electrical pain shooting down the leg. In severe cases, patients may also report numbness, tingling, burning, and weakness in the buttock and/or leg. Sciatica pain may affect a patient’s ability to tolerate prolonged sitting, standing, sleeping, and walking, greatly impacting the quality of life.
Causes of Sciatica
Sciatica results from pressure, or pinching, of a nerve root within the spine. Usually, this pressure is caused by a structure, near the nerve root, that has overgrown, been damaged, or lost its normal alignment. These structures include the bones of the vertebrae, the discs between the vertebrae, or even ligaments that surround the nerves.
Specific causes of sciatica include:
- Herniated discs
- Bone spurs
- Degenerative disc disease
- Spinal stenosis
- Foraminal stenosis
- Facet joint arthritis
- Compression fractures
- Tumors and cysts of the spine
Risk factors for developing sciatica include:
- Aging – As you get older, you accumulate more wear and tear, and damage to your spine.
- Scoliosis or Spondylolisthesis – Abnormal alignment of the spine creates unbalanced forces and stresses, which leads to accelerated wear and tear on joints and ligaments.
- Obesity – Carrying excess weight creates greater stress on your spine, leading to wear and tear.
- Improper lifting techniques/Occupation/Poor posture – Careers that require heavy work, including repetitive lifting, twisting, pushing, and pulling put you at higher risk of a herniated disc, spinal stenosis, and therefore sciatica. Careers involving prolonged sitting, such as driving a truck or a desk job, may also increase the risk of sciatica symptoms.
- Tobacco use – Tobacco use causes damage to small arteries in the body. As a result, your spine ages faster because it cannot heal damage effectively.
- Diabetes – Patients with diabetes, like smokers, have trouble healing the damage caused by everyday wear and tear. Therefore, the aging process is accelerated in your spine if you do not control blood glucose levels effectively. In addition, high blood glucose levels can directly damage nerves, including the sciatic nerve.
Diagnosis of Sciatica
Through a detailed history and exam, your doctor can distinguish whether your leg pain is caused by a pinched nerve, a blocked blood vessel, or a joint or muscle spasm in the leg. The exam typically includes:
- Range of motion test: Assessing how far you can move your spine in each direction and which movements cause your pain.
- Neurological assessment: A group of tests that evaluates your neurological system and may aid in pinpointing the area of the spine where your symptoms are originating. This assessment includes testing:
- Strength of the limbs
- Walking and balance assessments
- Sensation to light touch and pinprick
- Palpation: Touching, pushing, and squeezing of muscles and other structures to determine the source of pain.
Depending on what your doctor finds on your exam he or she may make a diagnosis of sciatica. If necessary, your doctor may order further testing to refine the diagnosis.
- X-ray: An image of the bones in your spine. An x-ray can locate arthritic changes in the vertebrae, including the location and severity of bone spurs. Load-bearing X-rays can also be used to assess abnormal bone alignment, which may contribute to your sciatica.
- MRI (magnetic resonance imaging): An image of the soft tissues of the spine, which cannot be seen on an X-ray. Most commonly an MRI will be ordered by the physician to locate the exact level of nerve compression causing sciatica. MRI can also locate tumors, damaged discs, and loose ligaments in the spine.
- Electromyography (EMG): An EMG measures the activity of the muscles at rest and during contraction, determining the communication of the nerve to the muscle. In an EMG test, needles are used in addition to electrodes. This study helps evaluate the extent of possible nerve damage involved in your sciatica. EMG also helps identify the location of neural compression, which may be outside of the spine.
Treatment of Sciatica
The two major goals of treatment for sciatica are:
- to decrease or eliminate painful symptoms
- to address the underlying cause of the sciatica to prevent recurrences of pain.
Conservative, non-surgical treatments are typically recommended first and are extremely effective for the majority of patients.
Conservative treatments include medication, physical therapy, and corticosteroid injections. One or all may be used to treat your sciatica symptoms.
- Commonly used medications:
- Over-the-counter medications, such as Advil or Tylenol, may be used to treat your pain if symptoms are mild or moderate.
- Muscle relaxers, such as Flexeril or Skelaxin, are used to treat spasms often associated with sciatica.
- Nerve membrane stabilizers, such as Neurontin or Lyrica, help reduce the irritability of pinched nerves that are causing sciatica.
- Opioids are used when pain symptoms are severe. Often, they are prescribed for short term use and are only used as a last resort if nothing else is helping with the pain
- Physical Therapy: Physical therapists can perform manual therapy and provide you with a program of stretching and exercises to help alleviate your symptoms more quickly than with just rest and medication alone. Physical Therapy may be prescribed in conjunction with other treatments such as pain medication and/or epidural injections to help with your symptoms.
- Epidural Injections: A physician performs an image-guided injection of corticosteroid, directly around the nerve root thought to be the source of your pain. The corticosteroid injection helps to decrease inflammation surrounding the nerve, acting like “a bucket of water thrown on the fire,” to help your severe pain. Typically, injections are performed in a series of two or three, depending on responses.
Surgical intervention may be indicated when symptoms do not improve with conservative treatment or you are experiencing progressive neurological impairment. Surgical Interventions include:
- Discectomy or Microdiscectomy: A minimally invasive procedure where a small portion of a herniated disc is removed, relieving pressure and related inflammation around the nerve root.
- Laminectomy: A portion of the vertebrae known as the lamina, along with overgrown joints or ligaments, are removed to allow nerve roots more room to travel within the spine. Laminectomy can be performed with minimally invasive techniques and can offer immediate relief of sciatica symptoms.
- Spinal Fusion: If spinal instability is contributing to your sciatica symptoms, simple decompression of the affected nerve with laminectomy may not be enough to relieve symptoms. In cases of instability, decompression has to be supplemented with stabilization and fusion of the unstable segment of your spine. This procedure is more involved than simple laminectomy and requires cages, bone graft, and often metal screws and rods. However, fusion can now be offered with minimally invasive techniques, allowing for rapid return to normal function.
NJ’s Most Comprehensive, Multidisciplinary Facility 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. Patients will receive comprehensive and coordinated care, so they can resume a healthy, less painful lifestyle free from disability by working with the CNSO leading board-certified neurosurgeons, orthopedic spine surgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists. CNSO 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.