Sciatica

Sciatica is pain in the distribution of the sciatic nerve, the largest and longest nerve in the human body. The sciatic nerve is formed by nerve roots coming from the lower, lumbar and sacral spine. It then runs down through the buttocks and legs to the feet and toes.

Patients with sciatica feel pain in the lower back and buttock which radiates down the back of the thigh, often to the calf, shin, ankle or foot. This pain may be mild, moderate or severe and very debilitating.

It is sometimes associated with tingling, pins and needles, or numbness. It may be hard to get comfortable in any one position and can be exacerbated by sitting, reaching, twisting or straining.

If you have pain in both legs or weakness in your legs or feet, numbness in your buttocks or perineum (groin), or a change in bladder and bowel function you should seek immediate medical attention.

Sciatica is a very common condition: most people have an 80-90% chance of experiencing back pain in their lifetime and 2-3% of these patients will go on to experience sciatica. Sciatica is most commonly due to irritation and / or compression of the lumbar or sacral (lower spine) nerve roots by a “slipped disc” or disc protrusion.

Diagnosis

The gold standard investigation of choice for sciatica is lumbosacral MRI (magnetic resonance imaging of the lower spine). This typically produces excellent images of bones (vertebrae), discs (intervertebral discs) and nerves in this region and allows for exact diagnosis. Sometimes additional diagnostic investigation is required such as SPECT-CT bone scan, EOS scan, flexion / extension X-ray or nerve conduction studies and electromyography (electrical studies). Occasionally, CT-guided nerve injections can be used for both diagnosis and treatment.

Treatment

There are many ways to treat sciatica. Commonly, initial conservative (non-operative) management to give your back a chance to get back to normal is reasonable. This can include:

medication including simple over-the-counter painkillers or prescribed medication such as mild opiates, short course low-dose muscle relaxants or nerve-type analgesia e.g. pregabalin, amitriptyline;
manual therapy and massage;
exercise, including physiotherapy with core strengthening;
posture optimisation;
weight optimisation;
reducing exacerbating factors e.g. ensuring workplace is ergonomic and reducing heavy lifting, twisting or straining;
CT-guided injections, usually a combination of local anaesthetic and steroid.

If you have a disc protrusion or spinal stenosis causing persistent or severe sciatica, numbness, weakness or problems with continence, this warrants consideration of surgical intervention.

Surgery for sciatica commonly involves removing the abnormal part of spinal disc, ligament or bone which is pressing on the lumbar or sacral nerve root or roots. This is known as lumbar decompression. The most common lumbar decompression operations are lumbar microdiscectomy and laminectomy.

Sometimes lumbar fusion, joining two or more vertebrae together, should be considered to stabilise and strengthen the spine e.g. for spondylolisthesis, degenerative disc disease, tumours or infection. lumbar disc replacement (Arthroplasty) may be indicated for select patient groups.

Dr Laban sees patients with all types of back pain related problems and conditions. Even though back pain is common, there can be underlying issues that you may not be aware of. If your back pain and related symptoms are getting in the way of life and not resolving then it is important to get an expert opinion. Patients often ask to see Dr Laban for a second opinion given his extensive knowledge and surgical expertise.