Sciatica

Sciatica refers to pain that is referred along the distribution of the sciatic nerve. This nerve is the largest in diameter of the human nerves and its fibers originate at the fourth lumbar vertebrae.

Sciatica is pain that is secondary to a disorder occurring in the lumbar (lower) spine. The pain usually travels through the buttocks and down the posterior thigh, often through the calf and into the foot.

The referred pain is often unilateral, but in some instances could affect both sides. It is often referred to as “burning” or “electrical” which may intensify with certain activities or position, specifically sitting, bending, sneezing, coughing or bowel movements.

Anatomy:
The sciatic nerve passes from the lower lumbar column, through the obtorator foramen, under the piriformis muscle into the posterior hip, buttock and down the posterior thigh, calf and into the foot.

Most commonly, sciatica is secondary to a herniated disc (see herniated discs for more information). It is rarely serious in relation to paralysis or permanent injury and the majority of time responds to conservative treatment. If progressive lower extremity weakness develops, “saddle” numbness or bladder/bowel incontinence or retention, please seek immediate medical care. This may be the onset of an infrequent medical condition termed “Cauda Equina Syndrome”.

Treatment:
As stated earlier, sciatica usually responds to conservative treatment with anti-inflammatory or corticosteroid medication. Narcotics may help break the acute pain cycle, but are not recommended for long-term use. Occasionally, increasing pain or failure of more conservative measures may warrant an epidural steroid injection (cortisone type injection into the area of the spine responsible for the symptoms).

Surgery:
If symptoms persist greater than 5-6 weeks without relief or if symptoms become intolerable, an MRI may be ordered to evaluate the extent of injury. This will give a more precise answer to your pain generator and give your surgeon more defined options. The surgical procedure will be dependent on the patient’s specific diagnosis and current symptoms. See “herniated discs” for the description of surgical procedures most commonly performed