It’s been compared to the worst toothache you can imagine. Like fire running down your leg. Some people say it’s even worse than labor pains because it shows no end in sight. These are descriptions of sciatica, and a severe case of this radiating nerve pain can bring anyone to their knees. That’s why many people don’t simply say they have sciatica—they’re a victim of it.
To get to the bottom of the sciatica story, SpineUniverse spoke to Dwight Tyndall, MD, FAAOS. Dr. Tyndall is a leader in the field of outpatient spine surgery, but he’s also a strong proponent of nonsurgical therapies to manage back pain—including sciatica. Dr. Tyndall shares his insights on sciatica and reveals the one red flag sciatica symptom that usually warrants surgery.
Q: What exactly is sciatica? Some people think it’s a spinal disorder, and others consider it a catch-all term for a group of symptoms.
Dr. Tyndall: Both statements are technically correct. Sciatica is a spinal condition characterized by nerve pain down the sciatic nerve. The sciatic nerve is the largest nerve in the body, and it’s comprised of spinal nerves from L4 in your low back down to S1 in the sacrum—so anything that affects those nerves can lead to sciatica.
Sciatica’s symptoms can be grouped under the medical term dysesthesia, meaning any kind of abnormal sensation. Most people describe sciatica as an unusual sensation radiating from their low back into the left or right buttock, down to the back of their thigh and to their calf, and all the way down to the foot.
Q: What are the hallmark symptoms of true sciatica? Are there red flag symptoms that indicate urgent care is needed?
Dr. Tyndall: Sciatica’s tell-tale sign is pain from the buttocks down one leg. Red flags that you shouldn’t ignore include pain that’s not responsive to nonsurgical treatment and/or pain that limits your activity level and quality of life. Also, loss of motor function in one part of leg—usually a drop foot where you can’t lift your foot off the ground—usually requires surgery. Weakness in your leg is another red flag. Additional red flags are sciatica with bladder and bowel changes.
Q: Is sciatica the same as lumbar radiculopathy?
Dr. Tyndall: Yes and no. Most people view sciatica to be more acute than lumbar (low back) radiculopathy, but radiculopathy— which comes from the Latin radix meaning root—is a condition that affects the nerve at its root as it exits the spinal cord.
Sciatica and lumbar radiculopathy can both be caused by a pinched nerve in the spinal column from a disc herniation or stenosis, but kidney problems or a pelvic issue like endometriosis can also present sciatica-like symptoms.
Q: Does sciatica affect more men than women? Older people? Obese people? Is there a particular demographic at higher risk for sciatica?
Dr. Tyndall: From my clinical experience, men and women have the same risk of developing sciatica. Obesity also doesn’t play a role, either. In terms of age groups, sciatica peaks in your 30s and 40s, and the risk decreases as you reach your 50s.
Q: How common is sciatica?
Dr. Tyndall: Sciatica and low back pain often go together, but sciatica is far less common. While 80% of people experience low back pain at some point in their lives, only 2-3% will actually develop sciatica.
Q: When should a person with sciatica see the doctor?
Dr. Tyndall: You should see a doctor if the pain is not responding to over-the-counter (OTC) medications, or if you develop weakness in your leg. Also, you should see a doctor if your pain is so severe that your quality of life and activities are impacted, and if the sciatica is associated with bladder or bowel changes.
Q: Does it matter what type of doctor a person sees?
Dr. Tyndall: I think you should see any qualified clinical spine professional, whether that’s a chiropractor, internist, or spine surgeon. If you don’t have weakness in your leg and your pain recently began, a chiropractor or primary care physician will suffice. However, if you’re experiencing weakness in your leg, see a spine surgeon.
Q: What causes or contributes to sciatica’s development?
Dr. Tyndall: There are many external factors, but one of the biggest is your occupation. Someone who works in a manual labor industry like construction has a greater likelihood of developing sciatica because they put more wear and tear on their back.
Tiger Woods is an example of this: He developed sciatica because his profession as a golfer placed significant stress on his spine.
There is a genetic component, as some young people who don’t work in a strenuous job develop sciatica, but the genetic tie is not clearly defined.
Lastly, pregnancy can lead to sciatica. As the baby grows, it can put pressure on the low back, pelvis, and sciatic nerve. Delivering the baby is usually enough to eliminate sciatica caused by pregnancy.
Q: If someone has had sciatica, is it likely to recur?
Dr. Tyndall: This question is difficult to answer because many factors contribute to whether someone will get sciatica more than once. Sciatica is likely to recur if the spinal disc that contributed to sciatica the first time is severely damaged. The more damaged the disc, the more likely it is to re-herniate and cause sciatica again.
Also, if the patient continues to work in a high-physical stress environment, the risk of recurrence increases.
Q: Typically, how is sciatica evaluated?
Dr. Tyndall: The physical exam is key to a sciatica diagnosis. The straight-leg raise test is the classic diagnostic tool during a physical exam. During this test, you’ll be asked to lift up your leg while lying down. If that causes pain down your leg, you could have sciatica.
Other physical exams I’ve used are knee extension tests, when the patient extends their knee to a straight position (similar to a straight-leg raise). Also, I’ve asked patients to walk on their tip toes or on their heel to measure their strength. I’ve also observed how strong they are going down stairs and simply walking.
I can typically determine a sciatica diagnosis from a physical exam, but if imaging studies are needed to learn more, I will order a magnetic resonance imaging (MRI) scan.
Q: What treatments are effective for sciatica?
Dr. Tyndall: The good news is that 80% of patients will improve with time and nonsurgical therapies. OTC medications, such as NSAIDs (eg, ibuprofen), are effective at managing sciatica pain in most cases. If the pain doesn’t subside, your doctor may prescribe a low-dose steroid pack (to be taken over one week). If that doesn’t manage your pain, you may receive an epidural steroid injection (you will first need an MRI to pinpoint the injection area).
Other nonsurgical treatments worth exploring are chiropractic, acupuncture and physical therapy, and of course, time typically works wonders for pain.
Q: Is spine surgery ever necessary to treat sciatica?
Dr. Tyndall: Yes, but the good news is that the majority of people with sciatica don’t need surgery. And, your doctor may ask that you explore nonsurgical routes for 6 weeks, but your tolerance for pain is the true predictor as to when you need to discuss or to decide on the option of surgery.
Surgery may be necessary if symptoms worsen despite trying nonsurgical options, or if you have weakness in your leg. The surgical procedure to treat sciatica is called a lumbar microdiscectomy. It’s a standard procedure with very positive patient outcomes.
A lumbar microdiscectomy is similar to a traditional lumbar discectomy. Technological advances, such as the advent of operative microscopes, allow surgeons to make smaller incisions that are minimally traumatic to the body and result in a much quicker recovery for the patient.
Q: Can surgery be performed in an outpatient setting?
Dr. Tyndall: Yes, lumbar microdiscectomy can certainly be performed in an outpatient setting. Many patients enjoy the comfortable environment and are able to go home the same day of surgery.
Q: Is sciatica preventable?
Dr. Tyndall: Yes and no. Sciatica may be preventable if you don’t put significant and repeated stress on your back, which will decrease your chance of injuring a nerve. However, in today’s society—through our jobs and daily stresses of modern life—it’s hard to do that.
Fortunately, with the wealth of treatment options available, people can get relief from sciatic nerve pain.