Sciatica

Things to know: Sciatica is a common name when a person develops backache with pain in the lower limbs. Low back pain is a very common complaint and most people experience backache at some time or another. Fortunately, approximately 90% of episodes of low back pain are self-limiting and resolve within about six weeks, regardless of treatment.

 What does term sciatica mean?

The sciatic nerve is the longest in the body. It starts as nerve fibers from the spinal canal and through the hips travels till the feet.

Causes: Any compression, irritation of the nerve would cause symptoms of sciatica. The most common cause that we see in routine is lumbar disc disease. Other causes include spinal tumors, infections, trauma, pregnancy, etc.

Why the lumbar region: This is because the lumbar region bears the brunt of the body’s weight and posture.

Disc herniations can result from general wear and tear, such as jobs that require constant sitting. Prolapse often results from jobs that require lifting or straining.

Symptoms of sciatica: These can vary depending on the location of the herniation and the type of soft tissue/nerve affected. The patient may have low back pain and/or pain extending to the buttocks. Neural symptoms are due to compression or irritation of the nerve root adjacent to the disc. It may be characterized as a shooting pain. This pain occurs on the lateral aspect of the thigh, leg, and foot, extending to the toes.

Often, numbness or tingling occurs. There might be accompanying muscle weakness. Sometimes, a large disc prolapse can cause urinary symptoms.

Investigations: If the symptoms are significant and prolonged, one needs to consult a concerned doctor. We neurosurgeons first examine the patient. We need to rule out other causes of backache and leg pain.

Magnetic resonance imaging (MRI) is the investigation of choice. X-rays of the spine are done to check for spinal stability.

Treatment: The majority of small and moderate-sized herniated discs will heal themselves in about six weeks and do not require surgery.

Medical treatment: Medical treatment for lumbar disc disease is oriented in the form of physical therapy and medications. Non-steroidal anti-inflammatory medications (NSAIDs), forms the first line of treatment. These medications can help relieve both pain and inflammation. Muscle relaxants can provide short-term relief. A short course of oral corticosteroids can also be of benefit.

Many people with lumbar disc disease can benefit from a structured program of physical therapy. Many patients benefit from TENS. Other physical therapy modalities like heat therapy, electrical stimulation of muscles, ultrasound therapy can be applied.

Once severe pain reduces, the patient can be started on back exercises. This can assist with both strengthening of the abdominal and lower back muscles as well as overall conditioning of the body. They can be taught specific exercises that can be continued at home. Many patients benefit from yoga and pilates.

 Surgical treatment: Surgery is indicated for the extruded disc, larger disc, and discs which cause cauda equina syndrome. Disc surgery is done in various ways like endoscopic discectomy or microdiscectomy with the aid of an operating microscope. The preferential surgery is endoscopic removal, as it has small incision, minimal tissue handling, and a shorter stay in the hospital.

Minimally access surgery gives excellent results in the form of long term pain relief.

Conclusion: The majority of patients of sciatica improve with medical management. One should consult an expert to rule out any major problem. Many patients benefit from modification of lifestyle like exercises, weight loss, etc.