Sciatica
What is Sciatica?
Sciatica (or lumbar radiculopathy) refers to symptoms of scorching or electric jolt-like pain that discharges from the sciatic nerve of the lumbar spine and vibrates down through the backside of either leg.
The largest and longest nerve in the human body, your sciatic nerve extends from L3-L5 of your lower back and serves the muscles of your buttocks, thighs, and calves. Terminating all the way down in your toes, your sciatic nerve also enables sensation in your feet and legs.
Because your sciatic nerve occupies such prime real estate in your lower body, a pinched sciatic nerve can make everyday activities—such as standing, sitting, lifting, or extending the back—extremely uncomfortable.
Often confused with peripheral neuropathy, sciatica also produces characteristic symptoms of numbness or burning in the legs and feet. However, unlike peripheral neuropathy, sciatica rarely results in permanent nerve dysfunction. In fact, with qualified intervention and skilled pain management, sciatica is almost always reversible!
Sciatic nerve compression can result from a wide range of underlying causes. Common conditions that trigger sciatica include:
- Lumbar Disc Herniation: A bulging, protruding, or ruptured disc in the lumbar spine can swell into the space occupied by the sciatic nerve, impinging upon the sciatic nerve root and misfiring pain signals into the extremities.
- Degenerative Disc Disease: Deteriorated lumbar discs—in addition to suffering disc herniations at a significantly elevated rate than healthy discs—release inflammatory proteins that can aggravate sciatic nerve tissue.
- Piriformis Syndrome: An inflamed or tightened piriformis muscle, which overlies the sciatic nerve where it passes through the buttocks to innervate the legs, can restrict nerve signal conduction from the sciatic nerve into the lower limbs.
- Spinal Stenosis: Spinal stenosis—an abnormal tapering or constriction in the spinal column—can apply undue pressure to the sciatic nerve, generating stinging pain and disrupting nerve function.
- Spondylolisthesis (Slipped Vertebra): A dislocated lumbar vertebra—a common byproduct of injury or facet joint osteoarthritis—may encroach upon the sciatic nerve at its point of exit from the spinal cord, through the vertebra.
Concerned that your telltale symptoms of lower back and leg pain could be sciatica? Dr. Frazier, our nationally acclaimed orthopedic spine specialist, knows that non-surgical and minimally invasive techniques are the answer to reversing sciatic pain and restoring your spine health!
What are the Symptoms of Sciatica?
The hallmark of sciatica is leg pain that radiates down a single leg of the body; however, on rare occasions, both legs may be affected. Sciatica may be characterized as pain that comes and goes. But, moderate to severe cases of sciatica can restrict everyday activities or even require a visit to the emergency room. Symptoms of sciatica include:
- Leg Discomfort: Unilateral (or one-sided) leg pain that erupts from the sciatic nerve in the lower back or buttocks and pulsates down through the thigh, calf, foot, or toes
- Burning Pain: Stinging, electric, or searing pain that travels along the sciatic nerve tract
- Prickling Sensations: Tingling, weakness, or numbness in the hips, hamstrings, calves, feet, or toes
- Activity-Specific Pain: Pain that worsens with sudden movements (e.g. sneezing or coughing) or prolonged inactivity (e.g. lengthy episodes of sitting or standing)
- Episodic Pain Relief: Pain that is relieved by activities (such as lying on the back) that temporarily reduce sciatic nerve compression
- Pain while Walking: Attacks of muscular cramps or spasms in the hamstrings and calves that render walking incredibly painful—or at times—impossible
- Foot Drop; Difficulty engaging the foot while walking that makes flexing the toes extremely effortful
- Emergency Symptoms: Seek emergency medical services if your sciatica is accompanied by progressive weakness or paralysis in the legs; bowel or bladder dysfunction; or unrelenting numbness in the “saddle” region of your buttocks, inner thighs, or groin.
Looking for immediate but lasting solutions to sciatic pain? Dr. Frazier—lauded by the New York Times Magazine as a “Super Doctor”—has earned nearly 20 years of experience refining minimally invasive solutions and redefining sciatica relief!
What are the Treatments for Sciatica?
Noninvasive solutions to sciatica are normally pursued for at least six months before an individual is considered to be a candidate for spine surgery. Before your doctor discusses surgical options, he or she may recommend the following conservative techniques: self-care methods (including bed rest or heat & ice application to the lumbar spine); a guided regimen of pain relievers; physical therapy to strengthen and condition the spine; or chiropractic manipulation.
If conservative pain management techniques fail to remedy your sciatica—or your doctor deems your condition to be an emergency—your physician will assist you to explore surgical options for sciatica relief. Depending upon the precise cause of your sciatica, our board certified surgeon Dr. Frazier may recommend the following surgical techniques:
- Lumbar Laminectomy: This minimally invasive surgical procedure involves removing a tiny sliver of the lamina (or backside portion of a lumbar vertebra) to relieve sciatic nerve compression that results from spinal stenosis. This technique optimizes patient recovery times by using only a 1-inch incision to minimize postoperative pain and unnecessary scarring.
- Microdiscectomy: A microdiscectomy is a sophisticated solution to sciatica that uses video-assisted technology to visualize and decompress sciatic nerve impingement. Recommended for surgical candidates who suffer from a lumbar herniated disc, microdiscectomy involves extracting ruptured disc material and cleaning debris from the vicinity of irritated nerves.
- Lumbar Interbody Fusion (ALIF, TLIF, or XLIF): Similar to a microdiscectomy, an interbody fusion procedure involves removal of a ruptured or degenerated disc. However, unlike a microdiscectomy, an interbody fusion uses a spacer and bone graft to fuse together the space left behind by the extracted disc. This minimally invasive procedure, which provides additional stability to the spine, is often named according to the spot from which your surgeon accesses the spine. For example, in a PLIF (Posterior Lumbar Interbody Fusion), your surgeon approaches the spine from the mid-line of your back; in a LLIF (or Lateral Lumbar Interbody Fusion), the spine is accessed from the side.
Concerned that the severity of your sciatica may merit a different approach? Although Lumbar Laminectomies, Microdiscectomies, and Interbody Fusion procedures are the three most common corrective measures to eliminate sciatica, Dr. Frazier customizes each of his surgical procedures to maximize the recovery potential of every individual. Viewing you as a person and not a patient, Dr. Frazier has been delivering award-winning spine care for nearly 20 years!
Meet Dr. Daveed Frazier
Dr. Frazier is a Harvard-trained, board certified orthopedic spine surgeon. He’s held an academic appointment at Columbia University College of Physicians and Surgeons and New York’s SUNY Downstate. Dr. Frazier is also a respected lecturer, accomplished researcher, published author on spine disorders and treatment, and a consultant for several international spine companies.
After completing his undergraduate education at Brown University, Dr. Frazier attended Harvard Medical School, where he graduated cum laude. He completed a Harvard internship based at the New England Deaconess Hospital in Boston, MA, followed by a Harvard combined residency before becoming chief resident at Massachusetts General Hospital.