What is Sciatica?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

The sciatic nerve is the largest nerve in the human body. It begins in the lower lumbar region of the back and extends down the hips, buttocks, and legs, with branches ending all the way down at the feet. The sciatic nerve and its extensions provide sensation to the lower back and most of the legs and feet. When this nerve becomes compressed or irritated, the nerve pathways are interrupted, resulting in radiating pain, numbness, and tingling in the leg, otherwise known as sciatica.

Sciatica pain is actually a symptom rather than a medical condition, indicating that something else is not functioning properly within the body. The vertebrae within the spine are designed to protect the spinal cord, with intervertebral discs situated between them. These discs help cushion the spine and promote flexibility. Sometimes, the soft, jelly-like substance within these discs herniates out of its rightful place, causing increased pressure and irritation to the surrounding nerves. These herniated or “slipped” discs are often the cause of sciatic pain.

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More About Sciatica

lumbar foraminotomyAre you suffering from sharp, shooting pain that radiates down the back of your leg, possibly even reaching the toes? Do you experience a deep ache or burning sensation in the hip, buttock, or thigh area? Does this pain interfere with sitting, standing, or walking at times? Do you have a history of lower back pain or other back problems? If so, you may have sciatica.

In order to better understand sciatica, it’s helpful to review some basic human anatomy; particularly that of the spine and nervous system. The nervous system consists of the brain, spinal cord, and the peripheral nerves. The spinal cord attaches to the base of the brain and extends down the back of the body, encased in the protective vertebrae of the spine. The nerves that branch off of the spinal cord supply the body with sensation, assist the muscles with movement, and promote communication between the brain and the rest of the body.

The sciatic nerve may become irritated if a vertebra slips out of place, otherwise known as spondylolisthesis. Also, a tiny muscle deep within the buttocks, the piriformis muscle, can spasm. As a result, sciatic nerve irritation and compression occurs.

Because of age-related degenerative changes that occur in the spine, individuals over 60 are at increased risk of developing sciatica. Also, added pressure on the sciatic nerve may occur during pregnancy or in individuals who are obese. Occupations that involved frequent twisting, turning, and heavy lifting place an individual at higher risk for developing back problems, which in turn, may produce sciatic pain. Conversely, people who spend long hours sitting are also at increased risk for sciatica.

Symptoms of Sciatica

The primary symptom of sciatica is pain. In fact, sciatica is not the cause of the pain, sciatica is the pain. The cause of the pain is typically a slipped, bulging, or herniated disc, or any other condition–like a bone spur–that puts pressure on your sciatic nerve.

The pain caused by sciatica may be sharp, shooting, constant, intermittent, or dull. It may be exaggerated by physical activity or sitting in one position for long stretches. Whatever the pain may be, the location is important: the sciatic nerve travels through the lower half of the body, so you will feel sciatica in one or more of the following: lower back (lumbar region), hips, buttocks, and legs.

In severe cases of sciatica, walking may be difficult. 

How is Sciatica Diagnosed?

Sciatica is relatively easy to diagnose: if you feel pain in your lower back and/or legs, you probably have it. What exactly is causing it, however, must be determined by professionals. Diagnosis involves the following:

•  Physical Examination:

You physician will assess your response to specific motions or palpations (physical touch), testing flinching reactions in arms or legs, and assessing for atrophied muscles.

•  Symptom Assessment:

Your physician will want to know as much as possible about the symptoms you are experiencing. He or she will ask a series of questions about what the pain feels like and where you feel it.

•  Medical History:

As with any kind of disease or condition, diagnosis also needs to take into account your full medical history. This will include previous diagnoses, any drugs taken, previous surgeries, and other important pieces of information.

•  Diagnostic Imaging:

Though often believed to be a diagnosis in itself, medical imaging like X-rays or MRI scans are actually only meant to confirm that there’s a problem. This also lets the doctor see more exactly where the issue is taking place.

If you have already been diagnosed with sciatica, but you are not sure if you trust the diagnosis or you simply want a second opinion, we would be happy to provide. It’s sometimes a good idea to get a couple expert opinions.

What are the causes of sciatica?

low back pain

Sciatica occurs when the sciatic nerve is compressed, or pinched. This can be the result of a herniated or bulging disc, a bone spurs, or one of several other conditions.

All of these conditions may be caused by one of the following:

  • Age-related wear and tear
  • Back or neck strain due to repetitive physical activity, poor posture, imbalances in the musculature, or heavy lifting
  • Direct physical injury such as a car accident or fall
  • Genetics, whether or not the symptoms appeared in your parents

How is Sciatica treated?

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

How Much Does Sciatica Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. In the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

Calculate how much you've spent on back pain this year.
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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used in Diagnosis and Treatment of Sciatica

When diagnosing sciatica, the most commonly used equipment are X-rays, Magnetic Resonance Imaging (MRI) scans, or Computed Tomography (CT) scans.

  • X-rays. X-rays can show the space between bones, which indirectly paints a picture of missing or deteriorated cartilage.
  • MRI Scans. MRI scans allow physicians to see tissue and disc damage directly.
  • CT Scan. A computed tomography (CT) scan is like a more detailed x-ray.

If you have an MRI, X-ray, or CT Scan, the North American Spine medical staff will review it for free to see if you are a candidate for a procedure.

 

How Does Sciatica Compare to Other Spine Conditions?

This can be tricky to understand: sciatica is the name given to any condition that compresses the sciatic nerve. So, when you have sciatica, you also have one of several other conditions. These include:

  • Collapsed Disc
  • Herniated Disc
  • Spinal Stenosis
  • Slipped Disc
  • Bone Spurs
  • Disc Protrusion
  • Pinched Nerve
  • And more

While some of these terms are interchangeable, some are not. In general, all of these terms refer to stages in the process of disc herniation. A disc is a kind of shock absorber located between vertebral segments. When the disc loses its shape, herniation results. When this herniation thrusts itself onto the sciatic nerve, sciatica results.

Finally, most disc herniations are the result of an underlying process of deterioration called “Degenerative Disc Disease,” “Degenerative Spine Disease,” or “Arthritis of the Spine.”

Analogy: A Piece of Wood

Small sparks can cause big fires. This is the case with sciatica. If your sciatica nerve is pinched or impinged at any point, it can cause a firestorm through your whole lower back and leg. The pain may even burn like fire, but it may also produce tingling, stabbing, numbness, or other uncomfortable sensations.

Good Wood

Bad Wood

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