What is sciatica in the spine?

Sciatica, often referred to as nerve root compression or lumbar radiculopathy, occurs when a nerve that runs down the back of the leg to the foot becomes compressed. The pain is often deep and consistent. It can be triggered by activities such as walking or sitting.

Causes of sciatica (lumbar radiculopathy)

Lumbar radiculopathy is a spinal condition that occurs when a nerve in the lower back is compressed. Causes may include:

  • Herniated disc - the most common cause of lumbar radiculopathy is a herniated disc that compresses a nerve.
  • Foraminal stenosis - in older adults, the hole where the spinal nerve exits the spinal cord becomes narrowed due to a bone spur or arthritis.
  • Scar tissue - patients who have had previous spinal surgery may have scar tissue that has built up and is affecting the nerve root.

Risk factors for sciatica

Risk factors for developing sciatica include:
  • Age - lumbar radiculopathy is more common as people age.
  • Overweight or obesity - people who are overweight or obese are more likely to develop lumbar radiculopathy.
  • Sedative lifestyle - if you lead a sedative lifestyle, you are at greater risk of developing lumbar radiculopathy.
  • Smoking - people who smoke are at greater risk of developing lumbar radiculopathy.
  • Posture - people with poor posture are at greater risk of developing lumbar radiculopathy.

Symptoms of sciatica

Symptoms of sciatica include:

  • Leg numbness
  • Tingling or pain in the buttocks down to the foot
  • Weakness in muscles controlled by nerves affected
  • Localized back pain 
  • Hypersensitivity to light touch

Diagnosis for sciatica

Sciatica can be diagnosed in a physical exam with your spine doctor. Your doctor will take a full medical history, evaluate your symptoms, perform a full physical exam and order additional diagnostic testing when necessary.

Diagnostic testing to confirm lumbar radiculopathy include:

  • X-ray
    An X-ray can identify osteoarthritis or if there is an infection or tumor in the area where you are experiencing pain.

  • Magnetic resonance imaging (MRI)
    An MRI can provide detailed images of the soft tissues, disc, ligaments and nerves in the lumbar region of the spine.

  • Computed tomography scan (CT scan)
    A CT scan is an alternative diagnostic test for patients who are not candidates for an MRI. A CT scan can take detailed images of the lumbar spine to determine if you have a compressed nerve.

  • Electromyogram (EMG)
    Your doctor may order an EMG to evaluate the electrical activity along the nerve or determine if there has been damage to the nerve.

Treatment for sciatica

Your Mercy Health doctor will try to treat your sciatica with conservative treatments such as medications and physical therapy first. Most patients experience complete symptom relief within six weeks to three months. Treatments could include:
  • Rest and/or avoidance
    In some patients, they can experience relief by avoiding activities or strains that cause symptoms.

  • Over-the-counter or prescription anti-inflammatory medication

  • Physical therapy
    Physical therapy exercises or stretches can help relieve the symptoms of lumbar radiculopathy.

  • Epidural steroid injection
    An epidural spinal injection directly into the spine near the affected nerves can reduce inflammation to relieve the symptoms of lumbar radiculopathy.

If your symptoms are not relieved or are getting worse with nonsurgical options after a few weeks, your Mercy Health team may recommend spinal surgery. The goal of spinal surgery is to relieve the pressure on the nerve in the affected area of the lumbar spine.

Spinal surgery options to treat sciatica include:

  • Laminectomy 
    During a laminectomy, your surgeon will remove a portion of the bone that covers the nerve. This will give the nerve more space and provide symptoms relief.

  • Discectomy
    During a discectomy, your surgeon will remove portion of a herniated disc that is compressing the nerve and causing your symptoms.

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