Q. What is sciatica and how is it treated?
A. Sciatica is a term that’s used frequently but not always accurately. It’s not a medical condition but a symptom: It refers to pain that radiates down the back of the leg, sometimes accompanied by weakness, tingling, or numbness. The pain follows the path of the sciatic nerve, which runs from the lower spine down the buttock and leg. The pain is usually constant but may feel worse with certain movements, and while coughing or sneezing.
Sciatica is caused by pressure on the sciatic nerve or damage to it, and the first step in treatment is to identify the underlying problem. Harvey Smith, a spine surgeon at New England Baptist Hospital, explains that the nerve is fed by several roots that emerge from the base of the spinal cord like a series of highway on-ramps, and a problem at the on-ramps is usually to blame for pain felt farther down the nerve. The most typical cause, Smith says, is a herniated disk in the lower spine, which is a tear in the pads of cartilage that separate and cushion the vertebrae. The bone then presses on a sciatic nerve root.
Sciatica can often clear up on its own with proper self-care or management by a health professional. “The vast majority of people have good relief of their pain with time, with nonoperative management,’’ Smith says. The first step is usually treating with either over-the-counter or prescription anti-inflammatory drugs, and performing physical therapy exercises and stretches, which Smith says usually provides relief within about six weeks. If the pain persists, doctors will sometimes inject a corticosteroid into the site where the nerve is compressed for short-term relief.
For more serious cases of herniated disks that don’t respond to these treatments, Smith says, the next option is surgery. A doctor will first use MRI to confirm the site of nerve compression, and then will perform a diskectomy, which involves removing a section of a herniated disk that’s causing pain, or a microdiskectomy, which is the same operation performed through a small incision guided by a microscope.
Smith says that while most episodes of sciatica are not emergencies, if sciatic pain is accompanied by problems with bladder or bowel control, it may be a sign of a serious condition called cauda equina syndrome. In this case, seek help immediately.