Sciatica and its relationship to excess weight

Clinical research has found that people with excess weight are more likely to have sciatica. Leading consultant orthopaedic spinal surgeon Mr Will Kieffer speaks to Top Doctors about the two conditions' relation to one another, alongside how sciatica can get better on its own in people of all body sizes. 

He considers other topics such as sciatica management, and what's involved in sciatica surgery, in this informative article. 

What is the relationship between obesity and sciatica?

There's a relatively strong relationship between obesity and sciatica. It's difficult to prove a causative effect and certainly being less active can be a causing factor of sciatica. 

There's a big piece of research that was done, that looked at obesity and sciatica, and leg pain as a result of nerve pressure, and it was very strongly linked. Actually it was linked to; the more overweight you are, the more likely you are to suffer from sciatica. 

How is sciatica managed in patients who are overweight or obese?

The good news about managing sciatica regardless of your body size is that the majority of patients will get better on their own. And that's statistically probably about 70 to 80 per cent over the first six weeks or so, so sciatica is often a self-limiting condition. 

The challenge comes in when that sciatica doesn't settle on it's own, or if it's associated with some rarer symptoms such as weakness in leg or in the foot, or loss of sensation. Or indeed, problems with the bladder or bowel, which are surgical emergencies. And in that case, then, escalating treatment through injection treatments to try and calm down the inflammation around the disc if that's the cause of the sciatica, or indeed surgery to relieve pressure on the nerves, to relieve the neurological damage that's happening. There can then be the other options moving forward.  

When is surgery recommended?

Surgery's generally recommended as an emergency for patients who have pressure on the nerves that supply their bladder and bowel. That's a condition called cauda equina syndrome. The other recommend surgical treatment is if someone's developed weakness that's progressive, or loss of function in their limb that's progressive. That's usually associated with a disc, and when there's more tightness around the nerves which is called spinal stenosis, then that's when all other treatments have failed and the patient's quality of life is suffering. That's the stage where surgery would generally be recommended.

How is sciatica surgery performed?

The treatments for sciatica surgeries are dependent on the cause of the leg pain. If that's due to a restriction of pressure on the nerves, for example, with tightness due to arthritis of the back of the spine, then the procedure is to relieve the pressure on those nerves by performing a decompression. This is to move, or take away, the arthritis and to free the nerves and the sac of nerves up. 

If it's disc herniation then the pressure comes from underneath from where the disc is, so again the procedure is usually from the back, which then involves moving down to get to that disc. So, moving the nerves out of the way to remove that disc herniation or disc prolapse, slipped disc that's come out and to free up the nerves in that respect. 

There are different types of sciatic procedure, therefore more or less relatively involved if it was a discectomy surgery, which is the removal of a prolapse or slipped disc, then that can be done as a day case procedure with a relatively short stay in hospital for one night. If it's a more wider-spread surgery, for example, to remove pressure on multiple areas of the spine, then that often takes a night or two in hospital.    

Is surgery a definitive treatment for sciatica? Or is further treatment required following surgery?

Surgery is often the definitive treatment. However, there's always a risk of recurrence with sciatica. If it's a disc herniation then there's risk of it coming back and interestingly, that's actually higher with surgery. That's because there's been surgical damage to the disc, whereas without surgery, your risk of a recurrent episode of sciatica is probably about five per cent over 10 years. So, one in twenty, which is pretty good statistics.

With stenosis, which is related to arthritis in the lumbar spine in the lower back, then that arthritis obviously hasn't been removed and it can progress, and therefore can regrow. The odds of that are probably about one in three over ten years, or slightly less.  

If you're looking for expert sciatica surgery, or require other orthopaedic treatment, visit Mr Kieffer's Top Doctors profile to arrange a consultation.