1. Sciatica Diagnosis Methods, Treatment Options, Surgical Options, Prognosis, & MoreIf your doctor has given you a sciatica diagnosis, it means that thereis an anatomical abnormality, such as a herniated disc, compressingthe sciatic nerve, the longest nerve in the body. Originating in thespinal cord in the lower back, the sciatic nerve stretches all the wayto the feet. It controls the muscles in the leg, enabling movementand allowing feeling to spread to the lower extremities. Sciatica isnot a disease or disorder, but rather a set of symptoms that resultsfrom an irritated sciatic nerve. If this nerve is injured or inflamed,radiating pain can manifest in the lower body, including a shootingpain that makes it difficult to stand, or pain in the buttocks or legs that worsens with prolongedsitting or standing. Other sciatica symptoms can include burning or tingling sensations,numbness or weakness in the legs and knees, or a pins-and-needles sensation in the calves ortoes.For the majority of people, sciatica will likely improve within a short period of time of the initialonset. However, there can be cases where there is no improvement in the sciatica symptoms forweeks or months, or the leg pain interferes with daily activities. In those circumstances, it’simportant to consult with a doctor or spine specialist.Determining if Sciatica is to BlameThe main goal of a medical consultation is to determine the cause and location of the patient’spain. Typically a consultation will involve a complete medical history of the patient as well as aphysical exam. Patients can prepare for the medical history in advance by writing downpertinent information related to the discomfort they’re experiencing, such as: • Past or recent injuries or accidents involving the neck, back, or legs • Previous episodes of back or leg pain • Frequency, duration, and nature of the existing pain • Conditions that make the pain worse or betterA physical exam will then be conducted to help determine the location of the patient’s pain. Thedoctor will ask the patient to perform neuromuscular tests in order to check muscle strength,range of motion, and reflexes. Patients may be asked to: • Sit, stand, and walk flat-footed, on the toes, and on the heels • Bend forward, backward, and sideways • Twist the torso • Lift the legs straight up while lying down or move in different positions • Bend and straighten the kneesAdditionally, the doctor will ask the patient pertinent questions including when the symptomsfirst developed, if the pain affects daily activities, and what type of self-care treatment methodshave been tried. The doctor may also check for muscle deterioration by measuring the calvesand thighs, and test for numbness or nerve sensitivity by touching parts of the body with a pin
2. or cotton swab. If necessary, imaging tests may be ordered to help the doctor make a propersciatica diagnosis by ruling out other causes related to the patient’s pain in the lower back,buttocks, legs, or feet. Imaging tests can include spinal X-rays, CT scans, and MRIs.X-rays can help the doctor first determine what may or may not be causing sciatica by takingpictures of the spinal area. Spinal X-rays can reveal any signs of infection, injury, or tumors alongthe sciatic nerve. CT scans (computerized tomography) take multiple cross-sectional images ofthe body to provide a detailed image of the spinal canal. The doctor will review the images,looking for any problems in the vertebrae such as a bulging or herniated disc or a bone fracture.MRIs, or magnetic resonance imaging, are similar to CT scans in that they create cross-sectionalimages of the body. However, unlike X-rays or CT scans that only detect bone structures, MRIscans allow doctors to see soft tissues, making it a very useful tool in forming a sciaticadiagnosis. MRIs can also detect other spine-related conditions that can cause sciatica, includingdegenerative disc disease, spondylolisthesis, spinal stenosis, piriformis syndrome, muscleinflammation, spine trauma, sciatic nerve tumor, and lower back infection.Treating Sciatica For patients who’ve received a diagnosis of sciatica from their doctor, there are a number of therapeutic options that can be recommended, including nonsurgical conservative and alternative treatments, as well as more targeted surgical options. Conservative therapies can range from hot and cold packs, the use of non-prescription medicine such as aspirin, ibuprofen, or acetaminophen, prescribed anti-inflammatory medication, and physical therapy exercises to strengthen and stretch the muscles in the lower back and legs. Alternative treatment methods can also provide sciatica relief, either in addition to or separate from other therapeutic options. Alternative treatments can include: • Acupuncture – This ancient practice originated in China more than 4,000 years ago. Thin needles are inserted into a patient’s skin at specific trigger points to release endorphins and opioids, the body’s natural painkillers. • Massage therapy – Massage therapy is known to increase blood circulation and relax tight muscles through the use of gentle manipulation or deep pressure application. For those patients diagnosed with sciatica, massage therapies may help reduce inflammation and provide pain relief. • Chiropractic manipulation – This treatment is similar to massage in that it can alleviate pain through touch. It also incorporates gentle manual pressure to align and adjust the spinal column.
3. Sciatica Surgery OptionsAlthough the majority of people with sciatica symptoms respond well to conservative and/oralternative therapies within a few weeks of following self-care measures, there may be timeswhen some patients are not able to find relief and surgery may be recommended. Surgery isgenerally used as a last resort for patients who’ve received a sciatica diagnosis and whosesymptoms haven’t improved for weeks or months. For those patients, there are various types ofsurgery available including lumbar laminectomy and microdiscectomy.A lumbar laminectomy, or open decompression, involvesthe removal of the lamina, a bony plate located on each ofthe spine’s vertebra, to create more space for the nerves.Excess disc fragments and bone spurs may also be removed.The goal of a lumbar laminectomy is to alleviate lower leg orback pain associated with herniated and bulging discs,spinal stenosis, or degenerative disc disease.Microdiscectomy surgery is performed through a small incision in the lower back. The surgeonremoves the ruptured or bulging disc that is pinching the sciatic nerve or nerve roots, along withany bone fragments.There are also minimally invasive, endoscopic techniques available to those suffering fromsciatica that offer an alternative to invasive open spine surgery, including percutaneousendoscopic discectomy and endoscopic foraminotomy. Patients diagnosed with sciatica need toweigh the risks and benefits of any type of surgery before electing to proceed with an operation.PrognosisAlthough sciatic nerve pain can be uncomfortable, the majority of patients who receive asciatica diagnosis from their doctor can treat their symptoms successfully and preventrecurrences with conservative treatment.Consult with a spine specialist or health care provider to learn more about sciatica, its causes,symptoms, and diagnosis, in addition to available treatment and pain management options.