The term sciatica describes a condition of pain radiated from the post face of the buttock and thigh, always beyond / below the knee and which may be accompanied by tingling or even decreased muscle strength or tenderness of the affected (compressed) root territory.
Sciatica is characterized by one or more of the symptoms:
- Constant pain in one side of the thigh and leg (very rarely can be bilateral)
- Pain that is worse sitting or standing still
- Leg pain that is often referred to as a sharp, burning or tingling pain
- Muscle weakness and tingling, or difficulty moving the leg, foot or big toe
- Pain that radiates from the back of the buttock, thigh and leg (or the external anterum of the leg) although it can rarely even reach the foot.
Sciatica may be constant and permanent or dynamic, arising only in certain positions.
Although the symptoms of sciatica may be very disabling, permanent and irreversible nerve damage is rare.
The sciatic nerve is the largest nerve in the human body and is made up of several roots that come together, so symptomatology may be more typical of one root than another.
- The sciatic nerve typically begins at the root of L3
- At each level of the lower lumbar spine comes a root that will contribute to the formation of the sciatic nerve.
- The sciatic nerve runs down the posterior face of the buttock and thigh and bilateral leg.
NON-surgical treatment of sciatica
The goals of conservative treatment of sciatica are to relieve pain and reverse neurological symptoms caused by nerve compression. The spectrum of alternatives to achieve this goal is manifold – analgesic medication, wet heat alternating with cold, some types of spinal exercises (with or without physical therapy) and occasionally epidural or even root injection with cortisone can be very effective in some cases.
In addition to medical treatment, several other types of alternative treatments exist such as vertebral manipulation by a chiropractor, acupuncture, cognitive behavior therapy or even osteopathy.
Treatment of recurrent sciatica and low back pain
In general, the vast majority of sciatica cases resolve within 4-12 weeks. After acute pain relief the patient should enter a rehabilitation program to improve various aspects of the vicious and often aggravated pain posture, thus preventing further seizures from settling.
Ergonomic workplace assessment as well as lifestyle assessment can also contribute to decreasing the frequency of recurrent sciatica and low back pain.
When can surgery be beneficial?
If we look at evidence-based medicine regarding the results of sciatica treatment, the results of patients treated for sciatica by conservative and surgical techniques after 5 years are noticeably the same, ie both have back pain.
So what is the benefit of surgery in treating this type of sciatica?
So let’s see in which cases surgery is indicated. This assessment should be made on a case-by-case basis taking into account numerous factors that relate not only to the patient itself but also to the surgeon’s technique and experience:
- Severe, disabling pain that does not improve or worsens with conservative treatment.
- Pain that makes it difficult – or impossible – to participate in the activities of daily living.
- Pain that interferes with interpersonal relationship
- Nerve compression with bladder and anal sphincter compromise
- Worsening neurological signs (eg decreased muscle strength)