Sciatic pain can be identified by pain and tenderness down the leg which may be due to inflammation of sciatic nerve. The pain usually starts in the back and extends down of the legs resulting from acute nerve compression.
Major causes of sciatic pain are slipped/prolapsed disk, muscle tension (Piriformis syndrome), lumbar spinal stenosis, degenerative disc disease such as osteoarthritis and spondylolisthesis. Sciatic pain can give rise to pain in low back, buttock, thigh, knee and foot. The diagnosis is based on the physical examination, medical history of the patient and certain diagnostic tests such as x-ray, CT and MRI scan and Discogramn.
In most people, sciatic pain gets better on its own and heals within few days or weeks. However, in some people, pain is severe and needs to be treated. There are various treatment options for sciatic pain including surgical and non-surgical options. The non-surgical options for treating sciatic pain are as follows:
- Application of ice or heat
- Medications such as non-steroidal anti-inflammatory drugs including naproxen, ibuprofen and aspirin which can relieve pain and inflammation and steroids to decrease swelling and inflammation of the nerves.
- Epidural steroid injections are used to decrease the inflammation if sciatic pain is severe.
- There are numerous alternative treatments for sciatic pain which can effectively relieve the sciatic pain.
- These therapies include massage therapy, acupuncture and chiropractic manipulation.
- Physical therapy and exercises are also found to be useful for treating the sciatic pain.
If the sciatic pain is extremely severe and does not heal within 6-112 weeks, then spine surgery is recommended. Depending on the cause and duration of sciatic pain, surgery for sciatic pain is recommended.
Generally there are two types of surgical procedures suggested for sciatic pain including an open decompression (lumbar laminectomy) or microdecompression (microdiscectomy). When the sciatic pain results from the disc herniation, microdiscectomy surgery for sciatic pain is recommended. It is suggested after 4-6 weeks if patient does not experience relief by non-surgical options. However, this surgery may be considered before 4-6 weeks if the patient experiences severe pain and disability. If there is progressive weakness in the legs or sudden loss of bladder or bowel control, then urgent surgery is needed. About 90 to 95% of patients experience pain relief after this surgical procedure.
Lumbar laminectomy or open decompression is another type of surgery for sciatic pain. Sciatic pain may be caused by lumbar spinal stenosis. When patient experiences the sciatic pain beyond his tolerance level, this surgery is recommended. The laminectomy is preformed to remove a tiny portion of the bone over the nerve root or disc material from under the nerve root which can offer the nerve root enough space and a better healing environment. This surgery can effectively relieve the pain and improve the function in the patients with sciatic pain.
A new surgery called as the X stop is designed to reduce the symptoms of lumbar spinal stenosis which is FDA approved. This procedure includes inserting an implant in the very back of the spine which can prevent the patient from leaning backwards; this position can typically cause pain in the patients with lumbar spinal stenosis.
Surgery for sciatic pain is generally elective and it depends on patients wish to undergo surgery or not. It is usually recommended for the patients with spinal stenosis or herniated disc.