Sciatica: Causes, symptoms, and treatment options

Sciatica can significantly impact daily life, but with proper diagnosis and treatment, many patients can find relief from their symptoms.

Here, Mr Cyrus Jensen, renowned consultant trauma and orthopaedic spine surgeon, offers an expert insight into sciatica, discussing causes, symptoms, and both conservative and surgical treatment options.

What is sciatica?

Sciatica is a condition that causes pain radiating along the path of the sciatic nerve, which extends from the lower back through the hips and buttocks and down each leg. The pain can vary widely, from a mild ache to a sharp, burning sensation, or excruciating discomfort which is debilitating and can affect daily activities. Other common symptoms of sciatica include tingling, numbness, or weakness in the affected leg.

What are the causes of sciatica?

Sciatica is usually caused by compression or irritation of the sciatic nerve. Common causes include:

• Herniated disc: When the soft inner material of a disk in the spine protrudes outwards and presses on the sciatic nerve.
• Spinal stenosis: Narrowing of the spinal canal, which can compress the nerves, including the sciatic nerve.
• Degenerative disc disease: Breakdown of the discs between the vertebrae, leading to irritation or compression of the nerves.
• Spondylolisthesis: When a vertebra slips out of place and compresses the nerves in the lower back.
• Piriformis syndrome: Compression of the sciatic nerve by the piriformis muscle in the buttocks.

How is sciatica diagnosed? What diagnostic tests or procedures are typically used?

Diagnosing sciatica typically involves a review of medical history and a thorough physical examination to check the patient’s reflexes, muscle strength, and sensation in the legs. The specialist may then additionally perform the following diagnostic tests or procedures:

• Imaging tests: X-rays, MRI, or CT scans to visualise the spine and identify any structural abnormalities or herniated discs.
• Electromyography (EMG): The EMG test measures the electrical impulses produced by the nerves and muscles to assess nerve function.

What are the conservative treatment options for sciatica?

Fortunately, many cases of sciatica can be effectively managed without surgery. Conservative treatment options include:

• Medications: Medications, whether over-the-counter or through a prescription, such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants or analgesics, are utilised to alleviate pain and inflammation.
• Physical therapy: Exercises and stretches to improve flexibility, strengthen the muscles supporting the spine, and alleviate pressure on the sciatic nerve.
• Hot or cold therapy: Applying heat or cold packs to the affected area can help reduce inflammation and provide temporary relief from pain.
• Epidural steroid injections: Corticosteroid injections into the affected area of the spine to reduce inflammation and alleviate pain.

Is surgery necessary for sciatica?

In most cases, surgery for sciatica is considered a last resort when conservative treatments have failed to provide relief, or if there is severe nerve compression or significant functional impairment. Surgical options include:

• Microdiscectomy: A minimally invasive procedure to remove the herniated portion of a disk that is pressing on the sciatic nerve.
• Laminectomy: Surgical removal of a portion of the vertebrae or the bone spurs to relieve pressure on the nerves.
• Spinal fusion: Joining two or more vertebrae together with bone grafts or metal hardware to stabilise the spine and reduce pain.

What can I expect during the recovery process following surgery for sciatica?

The recovery process following surgery for sciatica can vary depending on the type of procedure performed and the patient’s individual factors.

Most surgeries for sciatica are performed on an outpatient basis, meaning patients can return home the same day. In some cases, a short hospital stay may be required. Patients will be prescribed pain medications to manage postoperative pain.

In addition, patients will be advised to start physical therapy soon after surgery to improve strength, flexibility, and mobility and prevent the recurrence of sciatica. It’s also essential to gradually resume activities and avoid heavy lifting or strenuous exercises during the initial recovery period. The specialist will provide guidance on when it's safe to resume normal activities.

If you require expert treatment and management for sciatica, schedule an appointment with Mr Cyrus Jensen via his Top Doctors profile today.