Sciatica or lumbar radiculopathy is a set of symptoms including pain caused by general compression or irritation of one (or more) of lumbar or sacral spinal nerve roots. Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve to cause the pain. Symptoms include lower back pain, buttock pain, and numbness, pain or weakness in various parts of the leg and foot. Other symptoms include a “pins and needles sensation, or tingling and difficulty moving or controlling the leg.
Sciatica Symptoms and Treatments
Typically, symptoms only manifest on one side of the body. The pain may radiate above the knee, but does not always. It may be associated with neurological dysfunction, such as weakness. The pain is characteristically of shooting type, quickly traveling along the course of the nerve and is investigated by our doctors.
- Sciatica is typically diagnosed by physical examination, and the history of the symptoms. Generally if a person reports the typical radiating pain in one leg as well as one or more neurological indications of nerve root tension or neurological deficit, sciatica can be diagnosed.
- The most applied diagnostic test is the straight leg raise test which is considered positive if pain in the distribution of the sciatic nerve is reproduced with between 30 and 70 degrees passive flexion of the straight leg.
- Imaging tests such as computerized tomography (CAT SCAN) or magnetic resonance imaging (MRI) can help with the diagnosis of lumbar disc herniation. These imaging modalities provide the best information about the lumbar spine and its contents. A lumbar discogram can also help her find a diagnosis in difficult cases. Radionuclide bone scan and plain radiography can also help if fracture or a bony abnormality such as a metastatic disease is being considered.
- When the cause of sciatica is lumbar disc herniation, most cases resolve spontaneously over a several weeks to months. Initially treatment in the first 2 to 4 weeks should be conservative. Conservative therapies include heat modalities, massage therapy, physical therapy, and use of non-steroidal anti-inflammatories. When conservative management fails, then other modalities (below) should be considered.
- Lumbar interlaminar/transforaminal epidural steroid injections. These nerve blocks typically performed with local anesthetics and steroids can be extremely effective in treatment of lumbar radiculopathy.
- Medication: Besides anti-inflammatories which have been mentioned above, neuroleptics such as Lyrica and Neurontin, and antidepressants such as Cymbalta can also be effective in treatment of neuropathic pain conditions such as lumbar radiculopathy
- Surgery for unilateral sciatica involves the removal of part of the disc, known as a discectomy.