What is “sciatica”
Sciatica is a term that is often applied to back pain, especially pain that radiates into the buttock, back of the thigh, and leg. Often I have patients saying things like, “ I don’t think I have a disk issue, its just sciatica” as if that explains away the problem. Often I hear patients say” I didn’t think I needed to see a doctor, it’s just my sciatica acting up”. Sciatica, however, is not a diagnosis, it is a label to describe certain symptoms. Many different things can cause sciatica. Persistent sciatica should not be ignored, as it not only can be effectively treated but can be a sign of more serious conditions. The most common cause of sciatica is nerve root irritation from the lower lumbar spine, typically from the L4-5 and L5-S1 disk space levels, either from disk issues, overgrown bone spurs, and ligaments or a combination of those factors. Less common causes of sciatica include SI (sacroiliac) joint dysfunction, piriformis syndrome, and hip bursitis. Even more rare causes include tumors, both benign and malignant, and infections.
Treatment for these conditions ranges from medications, to exercise to injections to surgery. The medical treatment of these conditions is similar, typically including NSAIDs, muscle relaxers, etc. However, the other more invasive treatments are very different. Therefore it is important to clearly pinpoint the source of the pain and diagnose the condition as accurately as possible. A good history of what causes and aggravates and relieves the pain is the first step. Certain physical exam maneuvers can further narrow things down. Imaging including x-rays and MRI can offer further detail. Despite all of this, diagnosis can still be difficult, as there is a lot of overlap between the spectrum of symptoms and the different structures that can cause sciatica. Sometimes a diagnostic injection is necessary to sort out the pain generator, either into disk-level of the spine, or SI joint or hip bursa. Sometimes multiple injections may be necessary to sort things out.
The good news is that once a diagnosis is made, treatment of sciatica can be very successful. Whether its simply an occasional use of an NSAID to an exercise regimen, to certain injections to even surgery, almost everybody with these symptoms can find relief. “Sciatica” should therefore not be dismissed, persistent sciatic symptoms should be investigated, diagnosed, and treated appropriately. If you are located in the Hoston Texas area and are in need of sciatica treatment, please contact one of our 5 Houston Area Orthopaedic Surgery Centers & Houston Sports Medicine centers.