Is Sciatica a Symptom or a Spinal Disorder?

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Sciatica is a general term for pain originating from the sciatic nerve in the lower back. Sciatica is a symptom of a lumbar spinal disorder that causes mild to sharp and sometimes excruciating pain back and leg pain. Patients with sciatica have described pain as mildly disturbing to severe, burning, aching, deep, and sometimes likened to sudden bolts of lightning.

woman walking with low back and leg painLower back and leg pain associated with sciatica can make walking difficult.Sciatic nerve pain can travel from the buttock area, down the back of the thigh, and into the leg. Leg pain is the classic hallmark of sciatica. Low back pain may accompany sciatica, and some patients experience sciatica pain that extends into the foot. Another characteristic of sciatica is it usually affects either the lower left or right side of the body.

Sciatica can make life miserable. Walking, standing, bending over, driving a car, working at a computer, catching up on household chores, sneezing or coughing, and other activities of daily living can cause sudden and intense pain. Patients who suffer sciatica, especially that of a more acute nature, report the symptoms can be disabling and disrupt their quality of life.

sciatica low back and leg painSciatica typically affects one side of the body's lower back and leg. The classic symptom is leg pain, and sensations including numbness and tingling are common.Why Sciatica Is Painful
One reason the sciatic nerve causes so much pain is because it is the longest nerve in the body! The nerve starts at the back of the pelvis and runs downward through the hip area and buttocks into each leg. Near the knee, the sciatic nerve divides into two nerves—the tibial and peroneal nerves. The tibial nerve runs behind the knee and the peroneal nerve runs along the side of the calf and ankle. Through the tibial and peroneal nerves, the sciatic nerve innervates (stimulates) the action of many muscles in the lower legs and enables feeling in the thighs, legs, and feet.

Other Sciatica Symptoms
Besides pain, other symptoms may accompany sciatica. These symptoms include sensations such as tingling, pins and needles, burning, numbness or muscle weakness. Such symptoms may be felt in the buttocks, thighs, behind the knees, calves, ankles, and sometimes the feet.

Common Causes of Sciatica
The most common causes of sciatica are bone spurs and/or a bulging or herniated disc in the low back (lumbar spine). Bone spurs result from degenerative changes affecting the bones and joints in the spine. A disc may bulge or rupture due to normal aging and/or events involving spinal wear and tear or poor body mechanics when lifting. When a disc herniates, the gel-like interior (nucleus pulposus) protrudes through the disc's tire-like outer ring (annulus fibrosus).

Whether the disc bulges or herniates, it can compress nearby spinal nerves leading to inflammation and pain. If the nucleus breaks through the annulus (herniates), chemicals are released from the nucleus causing further irritation of nerve(s) and soft tissues creating more swelling and compression.

compression of spinal nervesA herniated disc or bone spurs can compress or pinch fragile spinal nerve roots causing inflammation and pain typical of sciatica.Non-Surgical Sciatica Treatments
There are many different types of non-surgical therapies and rarely is spine surgery necessary. The treatment plan depends on the diagnosis—the cause of sciatica.

Non-operative treatment may involve one therapy or a combination:

Spine Surgery for Sciatica is Rarely Necessary
The good news is—the majority of patients with sciatica improve with time and without low back spine surgery. Only a small percentage of patients with symptoms of sciatica will ever require lumbar spine surgery to treat its cause.

In very rare cases, the cause of sciatica may result in loss of control of the bowel and/or bladder (eg, cauda equina syndrome). This is one situation that requires urgent medical attention and potentially surgical intervention.

Commentary by Robert E. Isaacs, MD

Sciatica is a group of symptoms a person may experience, the hallmark of which is radiating leg pain. Although many things can produce this pain syndrome, spinal stenosis, piriformis syndrome, pelvic tumor--a ruptured disc is considered the classic causative agent. Thankfully, in most cases, the pain is transient with less than 1% of patients eventually requiring spine surgery.

Updated on: 04/10/18
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6 Leading Causes of Sciatica
Robert E. Isaacs, MD
Director of Spine Surgery
Duke University Medical Center
Durham, NC
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6 Leading Causes of Sciatica

Sciatica, also referred to as lumbar radiculopathy, is mild to intense pain that radiates from the low back into the left or right leg. Other symptoms include numbness, tingling, and weakness.
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