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Understanding Sciatica: What You Should Know

What is sciatica? Many have heard the term but don’t understand how this painful condition is caused, diagnosed or treated, according to Praveen Kadimcherla, MD, an orthopedic spine surgeon at Atlantic Spine Center.

Sciatica isn’t actually a medical condition at all, but a term used to describe symptoms stemming from the compression of the sciatic nerve in the lower back. But sciatica cases all have one thing in common: While pain begins in nerve roots located on either side of the lower spine, it radiates down the length of the leg – depending on the affected side – in a way that can be worse than back pain alone.

Up to 80% of all adults are afflicted with lower back pain at some point in their lives, but sciatica accounts for only 5 to 10% of all lower back pain, according to the National Institutes of Health (NIH). For that small number of affected individuals, however, the pain can be excruciating, says Dr. Kadimcherla, who is fellowship-trained in orthopedic and spine neurosurgery.

“Some people compare the agony of sciatica to that of a toothache,” he says. “It’s not something that can or should be ignored. Sciatica should be looked at by a physician as soon as it develops.”

Sciatica causes and symptoms
Some people are more prone to sciatica than others, including those older than 45; tall people; smokers; and those dealing with acute mental stress. Occupational risk factors include frequent lifting, especially while bending and twisting; and driving, especially that which vibrates the whole body (like driving large vehicles).

But the pinched nerve causing sciatica pain can develop from several common back conditions, including:
Bulging or herniated spinal discs
Spinal stenosis (a narrowing of the spinal canal)
Scar tissue
Spinal bone spurs

In addition to lower back pain that radiates to the buttocks, hamstring muscle, calf and foot, sciatica symptoms include tingling and numbness, Dr. Kadimcherla says, and not necessarily only on one side.

“The radiating pain caused by sciatica can worsen with sitting, and the constant, sharp pain can affect standing or walking,” he explains. “Patients may experience weakness or loss of movement in their leg or foot. Sciatica can be serious.”

Tips on Diagnosing and treating sciatica
How can doctors tell if a patient has sciatica as opposed to another back problem? A common diagnostic test known as the straight leg raise is used to differentiate the condition from others.

During the test, patients are asked to lay flat on their back with their legs extended straight in front of them. The physician will slowly raise each leg and note at what elevation a patient’s pain begins. “This test helps your doctor determine where your sciatic nerve is being pinched and can help indicate the cause,” Dr. Kadimcherla says. X-rays or imaging scans such as CTs or MRIs may also be used to pinpoint sciatica’s cause once it’s been diagnosed.

Passive treatments for sciatica, such as bed rest, have largely been replaced by more active treatments in recent years. Conservative treatments are always attempted first, he says. They include:
Ice or heat
Over-the-counter or prescription pain relievers or muscle relaxants
Exercise and physical therapy
Epidural spinal injections

These treatments usually prove very effective for sciatica pain, Dr. Kadimcherla says. But when they don’t work – and pain is unremitting and prolonged – surgery may be used to correct the underlying condition causing sciatica. According to the NIH, about 30% of sciatica patients suffer long-term effects.

“Surgery for sciatica is usually reserved for situations when the pinched nerve causes major problems, including significant muscle weakness, loss of bowel or bladder control, or severe pain that keeps getting worse,” Dr. Kadimcherla says. “But for the vast majority of sciatica patients, the condition is temporary and easily treatable. Seeing a doctor promptly can make the difference.”

Atlantic Spine Center is a nationally recognized leader for endoscopic spine surgery with several locations in NJ and NYC.,

Praveen Kadimcherla, MD, is a board-certified orthopedic spine surgeon at Atlantic Spine Center.

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