Amongst my most commonly treated conditions is sciatica, which is characterised by pain which radiates from the lower spine. This discomfort can extend through the buttocks and legs. This pain, which ranges from mild to excruciating (medically termed lumbar radiculopathy) is a surprisingly common condition. While the general population has an 80-90% chance of experiencing back pain in their lifetime, more than one in fifty of these patients will go on to develop sciatica.
Symptoms are caused by the compression – sometimes in conjunction with irritation – of the sciatic nerve. This nerve is the largest nerve in the human body, running from the lower spine through the back of both thighs, and it only ends where you hit the ground. In fact, the sciatic nerve connects your spinal cord with your leg and foot muscles, so while it’s clearly playing a crucial role in everyday movement, it’s also easy to see how susceptible the nerve might be to strain, injury or exposure to damage. Often, this comes when a disc in the spine ‘slips’ to one side or the other, pressing on the sciatic nerve as it exits the spinal canal.
While sciatica is relatively prevalent, it’s very different from general back pain. Patients often describe it as one of the worst pains imaginable, and find it difficult to be comfortable in one position for as little as 10 minutes. While its distinctive radiating pain, which can spread to encompass both sides of the leg, is a well-known hallmark of sciatica, tingling and numbness are also classic giveaways.
If that sounds like you, don’t despair! While persistent sciatica may warrant an MRI scan, followed by examination and intervention, the condition’s more usual treatments are simpler and largely effective. They tend to begin with conservative management: that first step can include the use of painkillers, maintenance of a healthy weight and posture, as well as committing to regular tailored exercises. In other cases, injections (perineural, nerve root or transforaminal epidural) can be valuable weapons in the war against sciatica. Generally, this course of treatment is administered to patients experiencing pain down one leg which is linked to the irritation of a specific nerve root. Injections can also be used for diagnostic purposes (if, for instance, an MRI scan is unable to identify which nerve in particular is causing trouble), or to help patients undertake treatments like physiotherapy – which would otherwise be impossible – by alleviating particularly severe pain. Similarly, spinal epidural injections can be used when multiple roots are causing simultaneous problems; however, and while injections can be invaluable in avoiding open surgery, the doctor’s golden rule is as true for sciatica as anything else: nothing works for everyone. Therefore, it’s really important to discuss all your options thoroughly with a consultant before making a final decision about treatment.
Should surgical intervention be deemed necessary, rest assured that the prognosis is overwhelmingly positive. Studies show that 75-80% of patients are free of leg pain following surgery, and 65-70% remain pain-free after 5 years. While tingling and numbness might improve too, they’re less likely to be fully resolved by surgery and ultimately, outcomes are as various as the patients which experience them.
I’ve been at the forefront of spinal medicine for decades, and have extensive experience in evaluating these minute details which make-or-break effective treatment plans. From diagnosis to recovery, and through every stage in between, Spine Solutions offers the ultimate in-patient care and results.
This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.
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