Treatment and Diagnosis of Sciatica | Neurology

Sciatica

What is sciatica?

Sciatica is an indication of pain that radiates along the path of the sciatic nerve, which branches from the lower back through the hips and glutes and down each leg. Sciatica usually affects only one side of your body.

Sciatica occurs most often when a herniated disc, a bone spur in the spine, or narrowing of the spine (spinal stenosis) compresses part of the nerve. This causes swelling, pain, and often some deadness in the affected leg.

Although the pain associated with sciatica can be severe, most cases resolve with non-surgical treatments within a few weeks. People who have severe sciatica associated with significant leg weakness or bladder or bowel changes may be candidates for surgery.

Alternate name

  • Sciatic neuritis

Symptoms of sciatica

Pain that discharges from the lower spine (lumbar) to the buttock and back of the leg is the symbol of sciatica. You may feel the discomfort almost somewhere along the nerve path, but it likely to follow a path from the lower back to the buttock and the back of the thigh and calf.

Pain can vary widely, from a mild ache to a sharp burning impression or excruciating pain. Sometimes it can feel like a shock or electric shock. It can be worse when you cough or sneeze, and sitting for a long time can make symptoms worse. Typically only one side of your body is affected.

Some people also have shudder, tingling, or muscle weakness in the affected leg or foot. You may feel pain in one part of your leg and impassiveness in another part.

Sciatica occurs when the sciatic nerve is pinched, usually by a herniated disc in the spine or by an overgrowth of bone (bone spur) in the vertebrae. More rarely, the nerve can be compacted by a tumor or damaged by a disease such as diabetes.

Causes of sciatica

Sciatica occurs when the sciatic nerve is pinched, typically by a herniated disc in the spine or by an overgrowth of bone (bone spur) in the vertebrae. More rarely, the nerve can be compacted by a tumor or damaged by a disease such as diabetes.

Risk factors

Risk factors for sciatica include:

  • Years. Age-related changes in the spine, such as herniated discs and bone spurs, are the most common causes of sciatica.
  • Obesity. By collective stress on the spine, excess body weight can add to the spinal changes that trigger sciatica.
  • Occupation. A job that requires you to turn your back, carry heavy loads, or drive a motor vehicle for long periods of time can affect sciatica, but there is no conclusive evidence for this link.
  • Sitting for a long time. People who sit for long periods or have a sedentary lifestyle are more likely to develop sciatica than active people.
  • Diabetes. This disorder, which affects the way your body uses blood sugar, raises your risk of nerve damage.

Diagnosis of sciatica

During the physical exam, your doctor can monitor your muscle strength and reflexes. For example, you may be asked to walk on your toes or heels, get up from a squat, and while lying on your back, raise your legs one at a time. The pain that results from sciatica will generally get worse during these activities.

Imaging tests

Many people have herniated discs or bone limbs that will show up on X-rays and other imaging tests, but have no signs. Therefore, doctors do not usually order these tests unless the pain is severe or does not improve within a few weeks.

  • Bone scan. An X-ray of the spine may reveal an overgrowth of bone (bone spur) that may be demanding on a nerve.
  • MRI. This way uses a powerful magnet and radio waves to produce cross-sectional images of your back. An MRI produces detailed images of bones and soft tissues, such as herniated discs. During the test, you lie on a table that is moved toward the MRI machine.
  • Computed tomography. When a CT scan is used to image the spine, you may have a contrast dye injected into your spinal canal before the x-rays are taken, a procedure called a CT myelogram. The dye then circulates around the spinal cord and spinal nerves, which appear white on examination.
  • Electromyography (EMG). This test measures the electrical impulses produced by your nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated discs or narrowing of the spinal canal (spinal stenosis)

Treatment for sciatica

If your pain does not improve with self-care measures, your doctor may suggest some of the following treatments.

Medicines

The types of medications that may be prescribed for sciatica pain include:

  • Anti-inflammatory
  • Muscle relaxants
  • Narcotics
  • Tricyclic antidepressants
  • Anti-seizure drugs

Physical therapy

Once your acute pain recovers, your doctor or physical therapist can design a rehabilitation program to help avoid future injuries. This generally includes exercises to correct your posture, strengthen the muscles that support your back, and improve your flexibility.

Steroid injections

In some cases, your doctor may recommend injecting a corticosteroid medicine into the area around the affected nerve root. Corticosteroids help reduce pain by suppressing irritation around the irritated nerve. The effects typically wear off in a few months. The number of steroid injections you can receive is limited because the risk of serious side effects increases when the injections occur too often.

Surgery

This option is usually kept for when the compressed nerve causes significant faintness, loss of bowel or bladder control, or when you have pain that progressively worsens or does not improve with other therapies. Surgeons can remove the bone spur or the part of the herniated disc that is pressing on the pinched nerve.

Complications

Although most people make a full recovery from sciatica, often without treatment, sciatica can potentially cause permanent nerve damage. Seek immediate medical attention if you have:

  • Loss of sensation in the affected leg
  • Weakness in the affected leg
  • Loss of bowel or bladder function

Prevention

Sciatica cannot always be prevented, and the condition may recur. The following can play a key role in protecting your back:

  • Exercise regularly. To keep your back strong, pay special helpfulness to the core muscles – the muscles in the abdomen and lower back that are important for proper posture and alignment. Ask your doctor to commend detailed activities.
  • Maintain proper posture when sitting. Choose a seat with good lower back support, armrests, and a swivel base. Reflect placing a pillow or rolled towel on your lower back to maintain your normal curve. Keep your knees and hips level.
  • Use good body mechanics. If you are standing for long periods, rest one foot on a stool or small box from time to time. When lifting something heavy, let your lower edges do the work. Move up and down. Keep your back traditional and bend only your knees. Keep the load close to your body. Avoid lifting and turning simultaneously. Find a partner to lift if the object is heavy or uncomfortable.

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