Sciatica

These include the following:

• Age: Increasing age causing degenerative changes in the spine is the most common risk factor for sciatica. These changes can cause pressure on the sciatic nerve.
  
• Physical Fitness: Inactive lifestyle and lack of exercise can lead to weight problems and obesity causing stress on the spine. People who sit for long periods of time or lead a sedentary lifestyle are at increased risk of developing sciatica.
  
• Occupational Risks: If you are working in a job that involves heavy lifting, frequent twisting of the body, or long periods of driving a vehicle, you are at higher risk for developing sciatica.
  
• Genetics: This can play a role in back problems. Research has identified two genes that may predispose some people to disc problems.
  
• Diet: An unhealthy diet high in fat and calories can lead to overweight or obesity increasing your risk of living a sedentary lifestyle, a factor in sciatica development.
  
• Medical Factors: Certain medical conditions such as diabetes or cancer that has metastasised to the spine can cause sciatica.
  
• Smoking: Although smoking is not a direct cause of sciatica, smoking decreases circulation which can affect the delivery of nutrients to the discs. Smokers also don’t heal as well as non-smokers which can prolong pain after back injury or surgery.

Some medical conditions that can cause sciatica include:

• Herniated Discs in the low back area are the most common cause of Sciatica. A herniated disc is a condition caused by a tear in a disc allowing the disc contents to bulge outside of the disc. Sciatica occurs when the disc contents put pressure on the sciatic nerve. Symptoms related to herniated discs in the lumbar region include sharp, continuous back pain, weakness in the legs, and some loss of sensation to the leg and foot.
  
• Lumbar Spinal Stenosis is a narrowing of the spinal canal as we age, most commonly due to degenerative arthritis. This narrowing can cause pressure on the spinal cord or nerve roots. If stenosis is in the lumbar area, the lower back, sciatica can occur.
  
• Piriformis Syndrome: The piriformis muscle lies over the sciatic nerve, originating in the lumbar region and ending in the back of the thighs. Common in female runners, piriformis syndrome occurs when the piriformis muscle in the buttocks spasms putting pressure on the sciatic nerve. Other causes of this condition include prolonged sitting, auto accidents, and falls.
  
• Spondylolisthesis: A condition in which one vertebra has slipped out of place onto the vertebra below it. If this occurs in the lumbar area, the sciatic nerve may be compressed causing sciatica.
  
• Degenerative Disc Disease: A condition caused by wear and tear on the discs between the vertebrae causing them to lose their cushioning ability and can cause pressure on the sciatic nerve.
  
• Diabetes: People with diabetes are at an increased risk of nerve damage, including the sciatic nerve.
  
• Tumours: Although spinal tumorus are rare, cancer can spread from other parts of the body to the spine. Tumours that are pressing on the spinal cord or nerve roots can cause sciatic pain.
  
• Trauma: Injury to the sciatic nerve can occur from an injection, car accidents, gunshot wounds, or fall.

Common symptoms of sciatica include:

• Pain in the buttock area and leg
  
• Sharp, intense, shooting pain down the leg
  
• Numbness, burning or tingling to the leg or foot
  
• Weakness of the leg or foot
  
• Low back pain that radiates down to the buttock and leg
  
• Pain increases with coughing, sneezing, or straining
  
• Pain increases with bending backward
  
• Pain intensifies with prolonged sitting or standing

If you are experiencing progressive weakness in the legs or loss of bowel or bladder function, seek immediate medical attention. This may be symptoms of Cauda Equina Syndrome, a medical emergency.

Dr Hsu or Dr Singh will perform the following:

• Medical History
  
• Physical Examination with special attention on assessing neuromuscular function in the lower extremities.

Your NSWSS spinal surgeon may order medical tests to determine the cause of your sciatica depending on the results of the history and physical, how long you have had the pain, the severity of the pain, or if you have other serious illnesses such as cancer.

Diagnostic Studies may include:

• X-rays: a form of electromagnetic radiation that is used to take pictures of bones.
  
• MRI: magnetic and radio waves are used to create a computer image of soft tissue such as nerves and ligaments.
  
• CT scan: This test creates 3D images from multiple x-rays and shows your physician spinal structures not seen on regular x-ray.
  CT scan with myelogram: a type of medical imaging which is done by injecting contrast medium into the affected area of the spine followed by CT scan of the area that creates 3D images from multiple x-rays.
  
• Electromyogram (EMG): a test involving the placement of small needles into the muscles to monitor electrical activity. This test is used to detect the level of nerve root damage related to chronic pain.
  
• Nerve Conduction Tests: A non-invasive test to assess the speed of conduction in a nerve. Electrodes are placed on the skin and nerves are stimulated with a weak electrical impulse.

Acute sciatic pain will usually get better on its own. Treatment guidelines for acute sciatic pain include:

Physical Activity: Continue your normal daily activities as much as possible, avoiding any activities that worsen the pain. Bed rest is not recommended and in fact can make your pain worse.
Over the counter medications: NSAIDS (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen, acetaminophen, can help ease the pain until it resolves.
Ice or heat packs are often used for 20 minute intervals and repeated every 2 hours. Some patients find alternating between heat and ice is helpful.
Exercise: Dr Hsu or Dr Singh may refer you to a Physiotherapist to instruct you on exercises to strengthen your trunk and back muscles. Stretching exercises done passively without jerking movements can also be helpful.
Prescription Medications: Your NSWSS spinal surgeon may prescribe anti-inflammatory medications such as steroids. For severe pain, you may be prescribed narcotic pain medications, or muscle relaxants.
Epidural Steroid Injections: Injections administered into the spine to deliver anti-inflammatory medications directly to the painful area around the nerve.
Therapeutic Massage by a trained therapist can decrease muscle spasms
Manual Manipulation: Spinal adjustments to straighten the spine can be performed by Chiropractors, Osteopathic Physicians, and appropriated trained Physiotherapists.

Some of the medical diagnoses that may need surgical intervention for sciatic pain include:

• Herniated discs
  
• Lumbar Spinal Stenosis
  
• Spondylolisthesis
  
• Degenerative Disc Disease

Dr Hsu or Dr Singh will discuss which options are best for you depending on your specific circumstances.