The sciatic nerve starts in the lower back and travels behind the hip joint, through the buttocks, and along the back of each leg down to the feet. One of the largest nerves in the body, it provides movement and feeling to the hips and lower extremities. When the sciatic nerve is compressed it causes a condition called sciatica.
Compression is commonly caused by a bulging or herniated disc. Discs are the soft but strong cushions that sit between the vertebra. These discs act as shock absorbers for the spine during movements such as bending, lifting and twisting. The discs are made up of a strong outer wall called the annulus and a soft gel like inner core called the nucleus. Sometimes, the annulus can become weakened or damaged, causing the nucleus to herniate out, leading to nerve compression
Symptoms
Sciatica usually only affects one side of the body, although it can in some cases occur in both legs simultaneously.
Patients will experience one or more of the following symptoms ranging from mild to severe:
• shooting or burning pain felt in the buttock and down the back of the thigh.
• Numbness, tingling or weakness in one or both legs
• Pain aggravated by coughing, sitting, squatting
• Problems with urinary or bowel continence
• Dull aching pain in the lower back and buttocks
Diagnosis
Your doctor will order one or more tests to investigate the degree of compression in your spine.
• Magnetic resonance imaging (MRI)
• Computerized axial tomography (CAT)
Treatment
There are a number of treatment options that may provide relief from sciatica, and avoid the necessity of surgery. In some cases, surgery may be the only option after all other treatment options have been exhausted.
• Exercise- Physiotherapy
Regular exercise can help you build and maintain strength in the muscles of your arms and upper legs. This will improve your balance, ability to walk, bend and move about, as well as control pain. Swimming, Pilates and core strengthening exercises are excellent options.
• Medications
Nonsteroidal anti-inflammatories (commonly called NSAIDS) may also relieve pain. In addition, your doctor may prescribe other medications to help with pain and/or muscle spasm.
• Steroid injections (corticosteroid injections)
Injections directly into the area around the spinal cord (known as epidural injections) may provide a good temporary and occasional permanent relief.
Surgery
Some patients with severe or worsening symptoms may need surgery. If you have problems with bowel or bladder function or problems with walking, then surgery will likely be recommended. Two common surgical options are:
Minimally Invasive Lumbar Microdiscectomy
This minimally invasive surgical technique is used to remove the bulging or herniated portion of disc that is causing the nerve root compression. Surgery is performed through a small tubular retractor. This procedure requires significantly less muscle dissection than an open procedure, and patients typically experience less pain and quicker recovery times.
Laminectomy
This procedure is performed through a small incision. An opening in the lamina is made to relieve pressure on the nerve. By performing a laminectomy, more space for the nerves is created by removing the lamina (or roof) of one or more vertebrae.
Lumbar Microdiscectomy
A microdiscectomy is a minimally invasive or ‘keyhole’ procedure that involves the removal of the bulging or herniated portion of disc
Endoscopic Discectomy
In some cases, an endoscopic discectomy is able to be performed to remove the bulging or herniated portion of disc. Using a camera and endoscope, the surgeon is able to access the spine through a tiny incision. This procedure requires no muscle dissection and no removal of the bone, making it the least invasive of treatments.
