What is it?
Sciatica is a fairly common symptom caused by an underlying injury to your sciatic nerve, or an area that affects the nerve, such as your vertebrae (the bones in your neck and back). The sciatic nerve begins at your spinal cord, runs through your hips and buttocks, and then branches down each leg. It is the longest, and one of the most important, nerves in the body, and has a direct effect on your ability to control your lower limbs. Sciatica is presents as a moderate to severe pain, weakness or numbness in your back, buttocks, and legs.
Why does it occur?
There are several conditions involving the spine and the nerves in your back that can cause sciatica. Falling and other injuries, and sciatic nerve tumours, are other causes, as are herniated discs, spinal stenosis (abnormal narrowing of your lower spinal canal), spondylolisthesis (when one vertebra extends forward over another), or piriformis syndrome, which is when the muscle that connects the lower portion of your spine to your thigh bone tightens.
What are the symptoms?
Pain that flows from your lower back through your buttock area and into your lower limbs is very often a sign of sciatica. There may be other symptoms associated with injury to the sciatic nerve, such as pain that gets worse with movement, numbness, weakness or loss of feeling in your lower limbs, pins and needles in your feet, or loss of bowel or bladder control. The latter could indicate cauda equina syndrome, which requires urgent treatment.
How is it diagnosed?
Symptoms can vary from one person to another, so your consultant will start with a full medical history which will include finding out where the pain is, how it feels, and when it started. You will also be given a physical examination and a test of your muscle strength, reflexes, and as nerve test to determine how nerve impulses are being conducted by your sciatic nerve. Imaging, such as x-rays, CT and MRI scans will help to determine the exact cause of your sciatica.
How is it treated?
The best course of treatment will depend on a number of factors, including your age, the level of pain you are experiencing, and what type of activity levels you wish to maintain, or return to.
Your consultant may prescribe muscle relaxants and painkillers for some immediate relief. Steroid injections may be useful in some circumstances.
For cases involving severe pain, or if you have lost control of your bowel and bladder, or have developed weakness in certain muscle groups, surgery may be the best course of action.
The two most common types of surgery are discectomy, in which part of the disk that is pressing the sciatic nerve is removed, and microdiscectomy, in which the disc is removed through a small cut with the assistance of a microscope.
The One Orthopaedics team specialists
Consultant Orthopaedic Surgeon FRCS (Tr&Orth), Spine
Pain Management Consultant FRCA FFPMRCA