What is Causing my Sciatica?
I have a sharp shooting pain down my leg, now what? Is there any hope to recover on my own or will I need surgery to correct it?
Strange new pains can be concerning, especially if they are frequent and debilitating. Sciatica is a common cause of leg pain, thigh pain, and is often associated with conditions of the spine that can cause back pain. Thankfully however, sciatic nerve entrapment is not always a result of spinal stenosis and can be diagnosed and treated with a variety of different modalities. In this list we’ll go over some of the most common causes, associated diagnoses, and treatments available.
The sciatic nerve is one of the main pathways for signals from the brain to reach the lower extremities and vice versa. A sciatic nerve runs down each of your legs, fed by a series of nerve roots that exit from the lumbar spine. This pathway is vulnerable to a multitude of different impingements, injuries, and interruptions that can cause nerve irritation, pain, numbness, and a feeling of weakness in the lower extremities.
One of the most common causes of sciatica (irritation of the sciatic nerve) is known as piriformis syndrome. Piriformis syndrome occurs when the muscle deep within the buttocks behind the gluteus maximus begins to spasm, contract, or lock up. Because the sciatic nerve runs between the piriformis muscle and the gluteus maximus, the spasming of the piriformis can cause the nerve to become compressed or irritated. The symptoms of piriformis syndrome present similarly to sciatic nerve pain that originates in the lower back. The patient may experience numbness in the leg and foot, weakness in the leg, or a shooting electric pain that originates in the buttock and propagates to the leg.
The common causes for piriformis syndrome include;
- A slip and fall (injury)
- Certain medications that may cause muscle spasms
- Altered gait
- Long-distance running or athletic overexertion
- Internal bleeding/swelling
Thankfully most orthopedic physicians, physiatrists, or interventional pain management specialists can diagnose piriformis syndrome with a routine physical examination that will involve pressing on and stimulating certain muscles in the buttock to elicit a targeted and localized pain. If the physical examination is consistent with the location of the piriformis muscle, a prescribed therapy routine consisting of steroid injections and physical rehabilitation is usually successful in helping heal a damaged or torn piriformis. Once the inflammation and spasms cease, if you are still experiencing sciatic nerve pain, it may be time to look in to alternative causes.
When examining comorbid symptoms, a physician is typically able to diagnose the root cause of sciatic pain. In the event of piriformis syndrome the pain is very targeted in the buttocks, however if pressing on the piriformis muscle does not elicit pain, then it is time to look at the spine. Thing to consider when figuring out where your nerve is being pinched include;
- Do you have control of your bowels? Do you urinate more frequently or experience urinary incontinence/urgency?
- Do you have back pain, and is it localized to a specific area of the lower back?
- Have you suffered a traumatic injury to your lower back as the result of a slip and fall, or an auto accident?
- Are you overweight, or do you work a highly sedentary job?
- Do you smoke?
All of these will be questions on your physicians’ minds when they first begin to assess your condition. With loss of bowel control and urinary incontinence, one of the biggest concerns is cauda equina syndrome (horse tail syndrome), an uncommon but life-threatening condition involving the bundle of nerves that exits near the base of your spine called the cauda equina. This condition may result in permanent and irreversible paralysis if not treated immediately, and usually calls for a trip to the ER. Don’t be too afraid though, most mild cases of sciatica are not associated with your cauda equina, the symptoms that accompany leg pain also include urinary incontinence, drop foot (complete loss of function in one or both feet) and inability to stand up from a chair due to leg weakness.
More than likely you have a herniated disc in your lower back that is impinging on your nerve root. This is the most common cause of sciatica, and can be diagnosed through a series of tests including a physical examination and MRI or CT scan. A trained neurosurgeon should be able to distinguish the root cause of the nerve compression and recommend a treatment plan accordingly. If the onset of your symptoms was within the last 6 weeks, the best thing you can do is follow up with an interventional pain management physician who can administer epidural steroid injections at the site of the herniation followed by a routine of physical therapy to help break up calcified tissue and relieve inflammation irritating the nerve root. If this routine doesn’t offer any relief, it may be time to consider surgery.
Surgeries used to treat herniated discs vary, but by far the most effective are;
- Spinal fusion
- Laser surgery
Spinal fusion is the more traditional of the two options, which involves removing the entirety of the damaged disc, replacing it with a spacer and bone graft to promote fusion, and stabilizing the two joints with a set of pedicle screws and rods to ensure fusion will occur successfully.
Laser surgery, specifically the Deuk Laser Disc Repair is an alternative to fusion where only the damaged part of the disc is removed using a laser fiber and endoscopic camera. Unlike fusion no implants are needed to stabilize the spine after surgery, and normal motion of the spine is restored approximately 6 months after surgery.
Notice there were procedures left out of this list including artificial discs, laminectomy, and decompressive surgery. These were excluded because the results have not been consistently positive, and the body of research currently available for peer-review suggests that the long-term viability of these surgeries is much lower, and the risk to patients of needing a subsequent operation is much higher. Discuss your options with your surgeon or seek a second opinion if they do not thorough discuss the risks of surgery with you prior to any operation.
Thankfully most cases of sciatica can be resolved non-surgically with conservative techniques and cost-effective therapies. However if the root cause is originating from a herniated spinal disc, then about 15% of people will need surgery to help their body heal the injury. Thankfully for this percentage of the population, new and pioneering techniques like the Deuk Laser Disc Repair are being developed and improved upon to provide the quickest and most immediate return to normal life after surgery, and some of the greatest most clinically-proven results.