Sciatica

Sciatica (sy-AT-i-ka) is a form of lower back pain that usually moves from the buttocks down the back of the leg.

What Is Sciatica?

When something squeezes the sciatic nerve, the main nerve in the leg, people feel pain in the back of the lower body. That pain, frequently one-sided, but occasionally affecting both sides, called sciatica, usually moves down the buttocks to the leg below the knee, but it can go all the way down to the foot. Sciatica varies from mild, tingling pain to severe pain that leaves people unable to move. Some people with sciatica feel sharp pain in one part of the leg or hip and numbness in other parts. This pain gets worse after standing or sitting for a long time.

Sciatica is most common in people who are 30 to 70 years of age, and it affects about three times as many men as women. At risk are the following groups:

people who are sedentary (not very active)

people who exercise improperly

people who smoke

athletes

people who lift, bend, and twist in awkward positions in their jobs

pregnant women

tall people

What Causes Sciatica?

There are many ways the sciatic nerve can become compressed, but the exact cause is often unknown. The most common causes of sciatica are a herniated disc or a tumor within the spine. Discs are the pads between the bones (called vertebrae) of the spine. They are filled with a gelatin-like substance that cushions the vertebrae from the impact of walking, running, lifting, and similar activities. A disc that has torn and has this gelatin-like material oozing out of it is said to be herniated.

Other common causes of sciatica include bony irregularities of the vertebrae such as spondylolisthesis. Spinal stenosis is a less common cause. In some cases, diabetes or alcoholism can cause sciatica.

How Is Sciatica Diagnosed and Treated?

Sciatica is diagnosed through a medical history and a physical examination. Sciatica often clears up within several days to a week. It is usually treated with bed rest for a day or two (only if people cannot bear the pain), local heat, massage, pain relievers, and muscle relaxants. Sciatica tends to return and can become chronic. Chronic sciatica is treated by trying to alleviate the cause of the pain; people with this problem are advised to lose weight, improve their muscle tone and strength, and improve their posture. Surgery may be necessary in cases in which there is no relief from pain, disc disease, or spinal stenosis.

Surgical Treatment Techniques

Several surgical interventions are available for treating sciatica. The goal of surgery is to eliminate the source of pressure on the sciatic nerve.

Laser discectomy is the removal of herniated disc material using a laser technique. During this procedure laser energy is introduced under fluoroscopic guidance to remove tissue that has been pressing on nerves and causing pain or numbness.

Microdiscectomy is the removal of herniated disc material using a surgical microscope. Because this techniques involves a microscope, the incision remains small, which helps reduce disturbance of surrounding tissue.

Radiofrequency ablation uses radiofrequency energy to heat up and break bonds of small nerve tissue areas, creating small openings and decreasing pain for months and sometimes years.

Can Sciatica Be Prevented?

Sciatica or recurrence of sciatica can sometimes be prevented by standing, sitting, and lifting properly; exercising; and working in a safe environment. People can use chairs, desks, and equipment that support the back or help maintain good posture, and they can take precautions when lifting and bending.

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