You’ve has low back pain for some time. But now you’re having pain in the leg and a pins and needles feeling that runs through your buttock area and down your leg.
Your doctor says this may be sciatica. Sciatica results from pressure on the nerve roots that come from the spinal cord. These nerves branch from the spinal cord, exit through openings called neuroforamens between the vertebral bones of the lower spinal column and then merge to form the sciatic nerve. This nerve runs from your lower back,through your buttocks and down the back of each leg.
There are numerous conditions that can cause sciatica. A visit to your doctor – particularly if the pain persists for longer than a week, is severe, is becomingly progressively worse, or is associated with weakness or numbness in your leg – can help sort out the cause.
Sciatica symptoms typically start with a problem in the lower spine, such as:
- A HERNIATED DISC
Also called a ruptured or slipped disc, this is the most common cause of sciatica. Between each of the vertebral bones in your spinal column is a pad of tissue called a disc. A herniated disc occurs when the gel-like interior of the disc pushes through the disc’s tough outer lining.
This creates a bulge that can put pressure on the nerve roots.
- SPINAL STENOSIS
By the age of 50, most people’s spines show at least some signs of wear and tear of the discs and spinal (facet) joints. Because of this, spaces between the vertebrae narrow and bony growths or disc bulges may form, which can compress sciatic nerve roots.
Wear and tear changes can also lead to this condition, which is when one vertebrae slips forward slightly, thus narrowing the space available for the spinal nerve roots and potentially leading to sciatica.
There are a number of common causes of sciatic nerve compression. Among them are cysts or tumours in – or that crowd into – the spinal area, and compression of the sciatic nerve by the piriformis muscle in the buttocks area.
In addition, conditions can occur that have symptoms similar to those of sciatica. These include pain related to the joint (sacroiliac) that connects the spine to the pelvis, or nerve damage in the legs due to peripheral neuropathy, a potential complication of diabetes.
In a non-emergency situation, diagnosing the causes of radiating leg pain is reliant on a discussion of your symptoms, a review of your medical history, and a number of physical tests, such as moving your body in certain positions to determine whether it provokes pain, and testing your strength and reflexes. The key is to determine whether the symptoms are caused by sciatica and its most common causes, or by something else.
If sciatica is suspected, additional diagnostic testing may not be performed unless symptoms persist or don’t improve much after a couple of weeks of conservative therapy.
Suggestive Symptoms of Sciatica
Symptoms that indicate pressure on the sciatic nerve roots include one or more of the following, usually in only one leg:
- Deep, aching pain that radiates from your lower back, down through your buttock to the lower leg. When sciatica is caused by a herniated disc, the pain may become worse when sitting or straining.
- When sciatica is caused by spinal stenosis, pain may increase with walking or standing for a long time, and may diminish when you’re bending forward.
- A burning, stabbing or tingling sensation that may be felt all the way down the leg.
- Development of muscle weakness, numbness, or difficulty moving your leg or foot.
Sciatica pain usually isn’t an emergency, but if a nerve root becomes severely compressed, emergency surgery may be needed. Seek immediate medical attention if you experience any of the following signs and symptoms:
- Sudden severe or increasing pain.
- Sudden numbness, loss of feeling or weakness spreading to the groin area or to one or both legs.
- Loss of bladder or bowel control.
- Spinal Injection
When pain persists several weeks or months of non-surgical treatment fails to fully relieve symptoms for about 10 to 30% of people with non-emergency sciatica. In cases that aren’t severe and debilitating, one option is to continue with conservative treatment and hope for improvement over time.
Another option is an inflammation-reducing corticosteroid injection into the area where the nerve root is compressed. If effective, pain relief usually lasts a few months.
Surgery to relieve compression is an option when, despite conservative care, signs and symptoms remain fairly debilitating or if they begin to include muscle weakness or loss of bladder or bowel control. This is especially true with sciatica caused by spinal stenosis, which tends to be more progressive than sciatica caused by a herniated disc.
With spinal stenosis, the most common procedure involves removing the back portion of one vertebra or more to create more space within your spine. Bone fusion or supportive hardware may be used to improve stability of the spine, particularly if the vertebrae have slipped forward due to the wear-and-tear changes of spondylolisthesis.
With a herniated disc, disc material pressing on the nerve root is removed (discectomy). This can sometimes be done with small incisions and minimal damage to the surrounding tissues.