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Sciatica

Sciatica is pain in the lower extremity resulting from irritation of the sciatic nerve. The pain of sciatica is typically felt from the low back (lumbar area) to behind the thigh and radiating down below the knee. The sciatic nerve is the largest nerve in the body and begins from nerve roots in the lumbar spinal cord in the low back and extends through the buttock area to send nerve endings down the lower limb. The pain of sciatica is sometimes referred to as sciatic nerve pain.

Causes

While sciatica is most commonly a result of a lumbardisc herniation directly pressing on the nerve, any cause of irritation or inflammation of the sciatic nerve can reproduce the symptoms of sciatica. This irritation of nerves as a result of an abnormal intervertebral disc is referred to as radiculopathy. Aside from a pinched nerve from a disc, other causes of sciatica include irritation of the nerve from adjacent bone, tumors, muscle,internal bleeding, infections, injury, and other causes. Sometimes sciatica can occur because of irritation of the sciatic nerve during pregnancy.

Causes

While sciatica is most commonly a result of a lumbardisc herniation directly pressing on the nerve, any cause of irritation or inflammation of the sciatic nerve can reproduce the symptoms of sciatica. This irritation of nerves as a result of an abnormal intervertebral disc is referred to as radiculopathy. Aside from a pinched nerve from a disc, other causes of sciatica include irritation of the nerve from adjacent bone, tumors, muscle,internal bleeding, infections, injury, and other causes. Sometimes sciatica can occur because of irritation of the sciatic nerve during pregnancy.

What are sciatica symptoms?

Sciatica causes pain, a burning sensation, numbness, or tingling radiating from the lower back and upper buttock down the back of the thigh to the back of the leg. The result is lumbar pain, buttock pain, hip pain, and leg pain. Sometimes the pain radiates around the hip or buttock to feel like hip pain. While sciatica is often associated withlower back pain (lumbago), it can be present without low back pain. Severe sciatica can make walking difficult if not impossible. Sometimes the symptoms of sciatica are aggravated by walking or bending at the waist and relieved by lying down. The pain relief by changing positions can be partial or complete.

How is sciatica diagnosed?

Sciatica is diagnosed with a physical exam and medical history. The typical symptoms and certain examination maneuvers help the health care professional to diagnose sciatica. Sometimes, X-rays and other tests, such as CT scan, MRI scan, and electromyogram, are used to further define the exact causes of sciatica.

TREATMENT

If the sciatica pain is severe and has not gotten better within six to twelve weeks, it is generally reasonable to consider lower back surgery. Depending on the cause and the duration of the sciatica pain, one of two surgical procedures will typically be considered:

  • A microdiscectomy (or small open surgery)
  • A lumbar laminectomy (an open decompression)

In some situations, concussion-type symptoms can be missed. Patients may experience difficulty concentrating, increased mood swings, lethargy or aggression, and altered sleep habits among other symptoms. Medical evaluation is always wise even well after the injury has occured.

Microdiscectomy for Sciatica

In cases where the sciatica pain is due to a lumbar disc herniation, a microdiscectomy or small open surgery with magnification may be considered. In this surgery, the portion of the herniated disc that is pinching the nerve is removed. This surgery is generally considered after 4 to 6 weeks if the severe pain is not relieved by non-surgical means. If the patient’s pain and disability is severe, surgery may be considered sooner than 4 to 6 weeks. As a general rule, approximately 90% to 95% of patients will experience relief from their sciatica pain after this type of surgery.

Lumbar Laminectomy for Sciatica

In cases where the sciatica pain is due to lumbar spinal stenosis, a lumbar laminectomy may be recommended. In this surgery, the small portion of the bone and/or disc material that is pinching the nerve root is removed. Laminectomy surgery may be offered as an option if the spinal stenosis causes the patient’s activity tolerance to fall to an unacceptable level. The patient’s general health may also be a consideration in whether or not to have surgery. After a lumbar laminectomy (also called an open decompression), approximately 70% to 80% of patients typically experience relief from their

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