If you develop a pain that starts in your lower back or buttock and radiates down your leg, your problem may be sciatica.
Sciatica is an irritation of the sciatic nerve, which is the largest nerve in the human body. Sciatic nerves originate from several nerves in your lower back. These nerves branch outward from the spine and then come together at each buttock to form the sciatic nerve, which then radiates down each leg. Sciatic nerve pain radiates along the same path.
The typical first symptom is lower back pain that travels down one leg. Generally, symptoms include:
Depending on the location of the compressed nerve, your symptoms may worsen when you bend over, lift objects, twist, sit down, cough or sneeze.
Irritation of the sciatic nerve is caused by nerve root entrapment (also known as nerve compression, pinched nerve or entrapment neuropathy). This particular form of entrapment is called lumbar radiculopathy, since the damaged nerves roots are located in the lumbar (lower back) portion of the spine. The nerve compression itself may be caused by:
The animation below illustrates the anatomy of the spine and sciatic nerves and the mechanics of sciatic nerve pain and leg pain.
Mild sciatica can go away on its own. Self-care measures that may help include ceasing all activity that causes pain, performing stretches of your lower back, applying an ice pack intermittently to the area causing pain, and taking NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen.
If rest, icing or other self-care methods have not improved your condition after three days, consult a physiatrist, spine surgeon or your primary care doctor to discuss your symptoms. If you experience severe numbness, tingling or problems urinating, see a doctor as soon as possible.
Nonsurgical treatments may include applying cold packs or heat, medications and/or physical therapy. In some cases, epidural steroid injections may also help you return to full activity. Severe cases may require spinal decompression surgery.
Conservative treatment is aimed at pain reduction. It may include:
Your doctor or physical therapist may give you instruction about proper bending and lifting to avoid aggravating your condition. In some cases, epidural steroid injections may also help you return to full activity. Most people with sciatica get relief from their symptoms within several months.
For those patients who do not respond conservative care and experience persistent, disabling sciatica, surgery may be warranted. Your doctor will determine whether you are a candidate for surgery based on the duration and severity of symptoms. If your condition is causing cauda equina syndrome (which includes symptoms such as bladder dysfunction, incontinence or severe numbness in the buttocks) may be an indication that you should have immediate surgery.
The surgical treatment for sciatica is spinal decompression surgery. The goal is to remove any disc herniation or stenosis (narrowing of canal) that is pressing on the affected lumbar nerve to ease the leg pain and associated symptoms of numbness and weakness. There are several different decompression surgeries, dependent on which nerve roots are affected. They include:
In general, more than 90% of sciatica surgery patients have successful outcomes.
Learn more from the articles and other content below, or find the best sciatica doctor or surgeon at HSS for your particular condition and insurance.
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