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Spinal Conditions: Sciatica

Definition

Sciatica refers to pain that radiates down the leg. Typically the pain originates from a compressed nerve in the lumbar spine although, uncommonly, nerves can be compressed elsewhere in the buttock. The nerves most commonly compressed in the lumbar spine (L4, L5, and S1) join to create the sciatic nerve going down the back of the thigh. The L1, L2, and L3 nerves are less commonly compressed; they join to create the femoral nerve that travels down the front of the thigh.

Causes

The most common cause of pain radiating down the leg is a disc herniation pressing upon a spinal nerve. A disc herniation can come about during trauma or may occur suddenly without any clear cause. Foraminal stenosis, or narrowing of the foramen (hole) that the nerve exits the spine through, can also cause radiating leg pain. Foraminal stenosis usually results from bone spurs and a bulging disc that develops gradually.

Treatments and Prognosis

Most disc herniations improve spontaneously because the disc resorbs. About 50% of patients feel improvement within one month, and 80-90% of patients feel better by 3 months. As a result, the first treatment option is observation. Other options include medicines. Non-steroidal anti-inflammatories (ibuprofen, naproxen, etc.), oral steroids (prednisone), and nerve medicines (Neurontin, Lyrica) can sometimes help minimize pain as the disc resorbs. Epidural steroid injections under x-ray guidance frequently decrease the inflammation of the nerve and pain that results. Physical therapy has little role when the cause of sciatica is a disc herniation because exercise cannot relieve pressure on the nerve but can provide benefit when foraminal stenosis is causing the leg pain.

When more conservative approaches fail, or there is progressive leg weakness, surgery should be considered. The operation, typically a lumbar microdiscectomy, relieves leg pain in about 85% of patients.

Dr. Button is very experienced in treating sciatica. Please call 503-234-9861 to schedule a consult.

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