Sciatica Causes and Care in Northern New Jersey
What Causes Sciatica?
Not to be confused with the broader term, lumbar radiculopathy, sciatica stems from the sciatic nerve of the lumbar and sacral spine becoming inflamed or irritated. The sciatic nerve has five nerve roots – two from the lumbar spine (lower back) and three from the sacrum, forming a left and right sciatic nerve on either side of the body. As the longest and thickest nerve in the body, it travels from the parts of the lumbar spine posteriorly to the gluteal region, down the back of the leg. At the knee, it branches into other nerves, which continue down through the toes.
Common causes for sciatica include:
There is a gelatinous disc between the articulating bones of the spine. Disc herniation refers to the disc’s exterior (annulus) tears resulting in some of the central material (nucleus) extruding. Also referred to as a slipped disc, a herniated disc can lead to compression on the adjacent nerves or spinal cord. When this happens, nearby nerves, including the sciatic nerve, cause related symptoms of discomfort.
Bone spurs of the spine, or osteophytes, can develop along the vertebrae in response to natural wear and tear or trauma. These overgrowths cause the canals, called foramen, which the spinal cord and nerves pass through, to narrow, causing pressure on the nerves. The patient experiences pain or neurological symptoms from this compression in the corresponding spine and extremities (arms and legs), which the pinched nerve innervates. Bone spurs range from mild to severe, affecting the sciatic nerve at varying degrees.
Degenerative Disc Disease
Degenerative disc disease starts to affect most patients in their 30s to 50s but the rate of deterioration varies based on past injuries, lifestyle, health, and other factors. As spinal discs wear down, they may bulge, tear, or herniate, causing painful symptoms. If this occurs at the level of the spine where the sciatic nerve exists in the spinal cord, the patient would experience the symptoms associated with sciatica.
Depending on its severity and location, degenerative spine changes of the vertebral bones, called spondylosis, also may affect the sciatic nerve, leading to symptoms of sciatica.
Spinal stenosis refers to a portion of the spinal canal that is narrowed, and if severe enough would cause bilateral symptoms. Bilateral sciatica can be a symptom of this condition if the lumbar and sacral stenosis occurs at the levels exiting nerve roots that form the sciatic nerve.
Spinal stenosis is often caused by arthritis of the spine (spondylosis) but also may be the result of spondylolisthesis, trauma plus wear and tear of the vertebral bones, and discs that form the borders of the spinal canal. As the spinal canal is a space formed by the vertebra, if it becomes narrowed, it places pressure on the spinal cord and exiting nerve roots.
Foraminal stenosis occurs when the openings between the vertebral bones, called the neural foramen, are significantly narrow, causing compression on the nerve root and exiting the spinal canal.
At each level of the spine, the nerve roots that have branched off from the spinal cord exit the spinal canal and travel to other parts of the body. When this foraminal narrowing, or foraminal stenosis, affects the level of the lumbar spine and the sacral spine, it may impact the sciatic nerve, causing symptoms of sciatica. But if it is not both, it may just cause lumbar radiculopathy or a sacral radiculopathy
Facet Joint Arthritis
Facet joint syndrome is a spinal condition caused by inflamed or arthritic facets (vertebral joints), leading to back pain, stiffness, and other symptoms. It commonly occurs in the lower back and neck. It does not cause radiculopathy or sciatica.
Spine fractures are another possible cause of sciatica, specifically compression fractures. This condition is characterized by small breaks in the vertebrae that cause them to collapse and curve. It may result from trauma, osteoporosis, or another factor and can impact the sciatic nerve.
Spinal Tumors and Cysts
Though rarer than other causes, spinal tumors and cysts may lead to sciatica. Whether benign (noncancerous) or malignant (cancerous), growths along the spine have the potential to put pressure on the sciatic nerve and cause other issues.
Sciatica Signs and Symptoms
Sciatica typically affects one leg at a time, but symptoms can present in both legs. The most common symptom of sciatica is pain in the back, gluteal region and down the back of the legs. Patients often describe it as sharp, sudden pain or an electric shock sensation.
Sciatica may negatively impact the overall quality of life and the patient’s ability to perform everyday activities. For instance, they may find it difficult to sit, stand, or walk for long periods or to get a good night’s rest. In severe cases, patients may experience the following:
- Numbness in the lower back, buttocks, leg, or foot
- Muscle weakness along the sciatic nerve path
- Tingling or “pins and needles” in the leg, toes, or foot
- Loss of movement
Ranging from mild to severe, discomfort typically is felt through the gluteal area and down the back or outside of the thigh and possibly into the calf. This pain also may be isolated to a smaller point along the sciatic nerve pathway, down the back of the leg.
Patients with sciatica symptoms should consult a spine health specialist to receive an accurate diagnosis. Centers for Neurosurgery, Spine & Orthopedics is experienced in evaluating patients for sciatica and creating personalized treatment plans focused on the patient’s condition, health, and other factors. To
diagnose a patient, a physician first reviews their medical history and learns their symptoms. Next, they will perform a physical examination that may include the following:
- Palpating the muscles and other structures to pinpoint the source of the pain.
- Assessing range of motion and which movements cause pain and which relieve the symptoms.
- Performing a neurological assessment to determine where symptoms originate in the spine or the affected extremity.
The physician also may order an X-ray, magnetic resonance imaging (MRI), or electromyography (EMG). These yield a clearer picture of the bones and soft tissues in the spine, as well as muscle activity during periods of rest and contraction. Once the physical examination is complete, the physician can determine whether the symptoms are related to sciatica or a different medical condition. Then a treatment plan for the correct diagnosis will be provided for the patient.
Nonsurgical and Surgical Sciatica Treatment
The primary goals for a sciatica treatment plan are to minimize or eliminate painful symptoms, enhance mobility, and address underlying causes. For some patients, the inflammation that caused the sciatica resolves on its own. Other patients may require more in-depth medical attention.
Centers for Neurosurgery, Spine & Orthopedics first confirms the diagnosis of sciatica then and explores non-surgical treatments. For sciatica, treatment options follow the below stepwise process until the symptoms are alleviated:
- Physical therapy: A targeted physical therapy program with stretches and exercises that help increase flexibility and reduce nerve pressure can provide symptomatic relief.
- Medication: Over-the-counter (OTC) pain relievers, as well as muscle relaxers and nerve membrane stabilizers commonly are used to treat sciatica symptoms. If a conservative medication plan does not relieve pain, the physician may suggest opioids.
- Epidural steroid injections: An image-guided corticosteroid injection can help decrease inflammation and alleviate severe pain.
If a combination of conservative interventions proves ineffective or only marginally effective, the neurosurgeon or orthopedic spine surgeon may explore other sciatica treatments. The timeframe and choices depend on the patient’s specific condition or health status and may include the following surgical options:
- Discectomy or microdiscectomy: During this minimally invasive procedure, the spinal surgeon removes the parts of a herniated disc that are compressing the sciatic nerve.
- Laminectomy: In this procedure, the spine surgeon removes the lamina (bony arches at the posterior spine) to release sciatic nerve pressure.
- Spinal fusion: To restore anatomical spinal alignment, the surgeon trims or removes problematic areas and inserts a prosthetic to maintain stability.
While discussing the recommended treatment plan, Centers for Neurosurgery, Spine & Orthopedics providers review specific procedures, recovery, and possible outcomes with the patient. This helps create a framework for what to expect during their continuum of care.
Recovery and Prognosis
Recovery time depends on the patient’s condition and treatment plan. Most sciatica cases will not need back surgery. If surgery is necessary, the case takes one or two hours with a CSNO surgeon. The patient typically can resume normal daily activities within one week. The neurosurgeon or orthopedic spine surgeon will let the patient know when it is safe to resume more vigorous physical activity.
Depending on the treatment, the patient may be instructed to follow specific recommendations for a period, such as:
- Avoid bending, lifting, or twisting movements
- Limit or adjust everyday activities
- Remain active by walking
- Take time off from physically demanding jobs
- Rehabilitate and exercise with physical therapy
Follow-up appointments will be scheduled to monitor the recovery process. If symptoms persist or return in the future, the provider will recommend further action.
Request an Appointment for Sciatica Relief Today
Centers for Neurosurgery, Spine & Orthopedics takes a conservative approach to treat spine-related ailments, such as sciatica, with pain management, physiatrists, and physical therapy experts who will reduce the inflammation causing the pain.
The comprehensive care team is experienced in treating patients at all decrease of severity, including acute to chronic. CNSO’s leading board-certified neurosurgeons, orthopedic spine surgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists work together across disciplines to promote positive patient outcomes for sciatica patients.