What Are the Treatment Options for Sciatica Pain?

Sharp shooting and burning sciatica pain can come on without warning. It can dramatically affect a person’s quality of life and the ability to perform daily functions. According to one study, over 40 percent of people will experience sciatic pain at some point during their lives — knowing how to treat this condition is essential.

Fortunately, there are many surgical and nonsurgical treatment options which exist. In this guide, we will discuss the symptoms and causes of sciatica, then list some treatment options which may help.

What Are the Symptoms and Causes of Sciatic Pain?

The sciatic nerves are the largest nerves in the human body and sciatica occurs when those nerves become irritated. The sciatic nerves originate in the lower back and come together in the gluteus region to form the main sciatic nerves. One sciatic nerve travels down each leg, and can cause painful symptoms in both legs and buttocks when inflamed.

Symptoms of Sciatica

One of the primary symptoms of sciatica is a lower back pain that may radiate into the buttocks and extend down the leg. Specific telltale signs may include:

• Sharp shooting or burning nerve pain that radiates down one or both legs and sometimes into the foot. Experiencing back pain and leg pain at the same time is a telltale sign that you may have sciatica, rather than another form of back pain.
• Numbness in one or both legs.
• A feeling of pins and needles in one or both legs.
• Muscle weakness in the back or one or both legs.

Causes of Sciatica

Sciatica occurs when the sciatic nerve becomes trapped and compressed in the lower back. This occurrence is called a pinched nerve, nerve compression, or sometimes nerve root entrapment, also known as entrapment neuropathy. A pinched sciatic nerve is known as lumbar radiculopathy since the lumbar spine — the lower back – is the site of the pinching or entrapment.

Several problems within the lumbar spine can lead to a pinched sciatic nerve, including:

• Herniated disc: A herniated disc is one of the most common causes of sciatic pain. The discs in the back are the small, fluid-filled sacs which sit between and cushion each of the spinal vertebrae. The discs usually sit in the center of the spinal column, but a disc can become herniated if it becomes misaligned. These tears and misalignments can occur because of a back injury or normal age-related wear and tear on the back. A herniated disc puts pressure on the nerve roots near the disc, pinching them and leading to nerve pain that extends down into the leg.
• Degenerative disc disease: Degenerative disc disease occurs when the discs in the spine break down over time. They flatten, reducing the cushioning between vertebrae, and can lead to nerve compression.
• Bone spur: A bone spur, also known as an osteophyte, is a bony projection that forms where two bones meet each other, such as the intersection of two vertebrae. A bone spur between two of the lumbar vertebrae can compress the nerves and lead to sciatic pain.
• Ankylosing spondylitis: Ankylosing spondylitis is an arthritic disease of the spine. The inflammation it causes can put pressure on the sciatic nerve.
• Spinal stenosis: Spinal stenosis occurs when the canal which contains the spinal nerves becomes narrowed. This narrowing often happens because of conditions related to aging, such as osteoarthritis and degenerative scoliosis, though it can occur in younger patients as well if spinal abnormalities are present.
• Piriformis syndrome: Piriformis syndrome occurs when the piriformis muscle in the buttocks compresses the sciatic nerve. Long periods of sitting or repetitive exertions such as long-distance running, especially with improper form or on uneven surfaces, can sometimes lead to piriformis syndrome.
• Other spinal inflammation: Inflammation of the lower back can also occur as a result of a number of different conditions. These include stress fractures, muscle strains, infections, and tumors in or near the spine. Pregnancy can also lead to spinal inflammation and result in sciatica.

How Is Sciatica Treated?

A few different treatment options for sciatica are available. Medical providers usually start with the most conservative treatment options and move on to more aggressive treatments if conservative remedies are ineffective.

Nonsurgical Treatments

Some of the nonsurgical remedies for sciatica include the following:

• Physical therapy, often including lower back stretches and muscle-strengthening exercises of the core to maintain proper alignment and stability.
• Spinal decompression, DRX9000™, a type of physical therapy that uses a traction system to stretch the back and potentially realign a herniated disc.
• Game Ready® Treatment Technology, which uses cold therapy with compression therapy to reduce inflammation.
• The AlterG® Anti-Gravity Treadmill™, which allows patients in our offices to experience a weightless effect and reduced pain as they walk to build muscle strength, improve fitness and restore range of motion.
• Acupuncture or other alternative therapies.
• Yoga stretches can help stretch the back and hamstrings as well as open the hips.
• Anti-inflammatory medications, such as NSAIDs (non-steroidal anti-inflammatory drugs).
• Muscle relaxants.
• Epidural steroid injections.

Patients may also be instructed to avoid bending at the waist and lifting heavy objects, since these actions are likely to aggravate the sciatic pain. By using a combination of these treatments, people with sciatic pain generally experience relief within a few weeks or months rather than a prolonged period of time if treatments are carried out independently of one another. In about 75 percent of cases of combined treatment, symptoms improve within a few weeks.

Surgical Treatments

If conservative treatments do not work, and if chronic, debilitating sciatic pain is reducing a person’s quality of life, then medical providers may suggest surgical options.

The surgery commonly used to relieve sciatica is called a laminectomy, which is a type of spinal decompression surgery. The goal of this surgery is to remove whatever is compressing the sciatic nerve, whether that is a herniated disc or a narrowing of the spinal column, and treatment outcomes are largely successful. Spinal decompression surgery can take several different forms, depending on the cause of sciatica and which branches of the nerve are compressed.

Fortunately, doctors can perform many of the surgical treatments for sciatica with minimally invasive techniques, so patients are often feeling better and back on their feet sooner when compared to traditional open surgeries.

Some common types of surgical treatments for sciatica pain are:

1. Discectomy

A discectomy removes a portion of the bulging, herniated disc. Discectomy, often paired with laminectomy, is more effective at treating radiating pain than localized back pain, and this effectiveness makes it a suitable choice for the radiating pain of sciatica.

2. Microdiscectomy

As its name suggests, a microdiscectomy removes a tiny piece of the herniated disc. This type of surgery is less invasive than a traditional discectomy — it makes small incisions and uses a small video camera and/or microscope to help surgeons monitor the procedure.

3. Laminectomy

A laminectomy creates space in the spinal column by removing the lamina — the rear portion of a vertebra. Removing the lamina makes the spinal canal larger and eases pressure on the spinal cord and nerves. Many times, a laminectomy is performed together with a microdiscectomy if a discectomy alone will be insufficient to relieve the pressure.

4. Spinal Fusion

After any of the surgeries listed above, the surgeon may also perform a spinal fusion. This procedure fuses two or more vertebrae to help stabilize the spine. If a large part of the disc had to be removed, a fusion would prevent the two adjacent vertebrae from rubbing together and causing tremendous pain.

When Is It Time to do Surgery for Sciatica?

When patients experience ongoing sciatic pain, they often wonder how long they should wait before thinking seriously about surgical options. Surgical procedures are not to be undertaken lightly, but sometimes they provide the best option in a challenging situation.

Several factors or symptoms may indicate that surgical options have become the most promising remedy, such as:

• Ineffectiveness of conservative treatment: Because spinal surgery carries some risks, medical providers typically recommend this option only when they have exhausted all conservative methods of treatment and the patient has not experienced relief. If multiple forms of conservative treatments have been unsuccessful, surgical options become viable.
• Long-term pain: If sciatic pain has persisted for several months, despite the patient’s best efforts with conservative treatment, the continuation of symptoms may be a sign that surgical treatment is warranted.
• Diminished quality of life: If sciatic pain is debilitating and the patient is unable to function normally because of it, surgical options may be a necessity. Muscle weakness, poor coordination and trouble walking can be part of this determination, but so can unremitting pain. If sciatic pain and symptoms get to this point, a conversation with a Surgical Spinal Specialist about surgical options is probably necessary.
• Cauda equina syndrome (CES): The cauda equina — literally “the horse’s tail” — is a collection of nerves at the bottom of the spine. A patient may develop cauda equina syndrome when this collection of nerves becomes compressed in such a way that they cause malfunctions of the bladder and lower extremities. Symptoms associated with cauda equina can include severe lower back pain, bladder or bowel incontinence, loss of sensation in the buttocks area and legs and impaired motor function of the legs. Left untreated, cauda equina can lead to permanent paralysis and incontinence, so these symptoms are cause for emergency surgical treatment.

Questions to Ask Before Sciatica Surgery

Choosing to undergo spinal surgery for sciatica is a serious decision, so it’s essential to have as much information as possible before making it. Below are a few questions that patients may want to ask their physicians or spinal surgeons before agreeing to surgery:

1. What Do We Know About the Specific Cause of Sciatica?

Different causes of sciatica may require different surgical interventions. Sciatica caused by a herniated disc may require and respond well to a conventional laminotomy or microdiscectomy, but sciatica caused by piriformis necessitates surgical treatment much less frequently. Be sure you know what specific cause of sciatica the surgery will address, and make sure it has a good chance of doing so effectively.

2. What Other Treatments Are Available?

Before committing to surgery, it’s worth exploring more conservative options that you may not have tried yet. If you’ve already tried physical therapy and exercise, it might be worth trying steroid injections or looking into alternative treatments like acupuncture. On the other hand, if your pain is severe and resistant to conservative methods, cycling through different treatments may be frustrating when surgery is likely to bring more reliable relief.

3. How Is My Quality of Life Likely to Change?

Talk to your doctor about the realistic prognosis for your quality of life with and without spinal surgery. A medical professional will be able to help you determine whether your condition is likely to deteriorate, get better, or remain the same over time. If your sciatic pain threatens to impede your quality of life without surgical intervention — especially if what has begun as inflammation is likely to become permanent nerve damage — surgery may become a viable option.

4. What Can I Expect to Gain From Sciatica Surgery?

Are you hoping to be able to participate in sports again? Or are you just hoping to be mostly free from pain? Most people experience a 90 percent improvement in their levels of sciatic pain after undergoing surgery. That leaves an average of 10 percent residual pain or lingering numbness. Knowing your goals for surgery helps you be more realistic about potential outcomes.

5. What Will the Recovery Be Like?

Most patients who undergo minimally invasive spine surgery are up and walking within the same day and can expect to heal within a few weeks, but these figures can vary depending on the patient and the intensity of the surgery. Being prepared for a lengthy healing process can also help patients be more realistic about spinal surgery.

6. What Are the Potential Risks?

The risks of spine surgery have to be weighed against the benefits. Incomplete alleviation of symptoms is one of those risks, but there are many others, most notably the risk of nerve damage and paralysis. The risks of undergoing general anesthesia can include blood clots and heart attack, and there is also the possibility that the surgical site could become infected and require additional medications or further surgeries.

Factors such as smoking, diabetes and high blood pressure can make the likelihood of complications higher, so be sure to discuss these with your doctor before making a decision. There’s also always the risk that sciatica could recur after surgery if the sciatic nerve becomes compressed in a different lumbar vertebra.

7. Do the Potential Advantages Outweigh the Risks?

One of the hardest things to assess — but also one of the most important questions to answer — is whether the potential benefits of spinal surgery outweigh the potential risks. This is where an in-depth discussion with medical professionals becomes most crucial.

Assessing the likelihood of improvements in your pain levels, functionality and overall well-being while being mindful of the risks involved in an operation is a complex calculation, so you’ll want to get as much professional insight as you can.

Contact Alliance Orthopedics to Discuss Your Sciatica Options

When you need reliable treatment for sciatica, contact Alliance Orthopedics. We specialize in pain management and offer both surgical and nonsurgical spinal treatments, including medication, physical therapy, therapeutic injections, acupuncture and spinal decompression.

In cases where conservative treatment has been ineffective, we can help patients assess their medical needs and determine whether surgery is the best option.

Make an appointment today to get on your way to get better.