Guide to Advanced Surgery for The Spine
Why Choose Cedars-Sinai Marina del Rey Hospital for Sciatica Treatment?
Multiple treatment approaches for sciatica are available at Cedars-Sinai Marina del Rey Hospital. The well-trained specialists and surgeons provide patients with both non-invasive and surgical treatment options, depending on the severity and type of the condition, in order to restore the patients’ health and improve their quality of life.
True sciatica is a condition that occurs when a herniated lumbar disc compresses one of the contributing roots of the sciatic nerve. This condition is often accompanied by low back pain, which can be more or less severe than the leg pain. The term "sciatica" indicates that the sciatic nerve, which travels from the lower back through the buttocks and into the leg, is thought to be the cause of the pain in this condition.
Sciatica is less common than other causes and conditions that produce back pain. For instance, sporting activities, recreational activities, and heavy labor can cause back and leg pain, which is commonly misdiagnosed as sciatica. The challenge for a physician is to distinguish between radicular pain, which is caused by an inflamed nerve root, and referred pain, which is a result of a musculoskeletal sprain or strain.
Sciatica Surgical Procedures Performed at Cedars-Sinai Marina del Rey Hospital
When medication, rest, physical therapy or other non-surgical therapies fail to provide lasting relief over the reasonable length of time, or if there is evidence that nerve root compression is causing nerve damage, your doctor may recommend spine surgery. The goal of surgery is to alleviate your symptoms and prevent further damage by removing the source of pressure on the spinal nerve roots.
Laminotomy »
Disctectomy »
Drugs and Other Treatment Needed for Sciatica
Your doctor will be able to discuss with you what your diagnosis means in terms of treatment options. Non-surgical therapies such as medication, rest or physical therapy are typically recommended first. These options include:
Acupuncture »
Biofeedback »
Physical therapy »
Tricyclic antidepressants »
Steroid injection »
Prescription pain medication »
Over-the-counter pain medications »
Prescription muscle relaxants »
Spondylolisthesis »
Piriformis syndrome »
Lumber Spinal Stenosis »
Herniated or Bulging disc »
Symptoms of Sciatica
The most common symptom of true sciatica is posterior thigh, lower leg or foot pain that can be much worse than the accompanying lower back pain.
- usually a patient will experience moderate to severe pain, which begins in the buttocks and runs down through the leg or foot
- true sciatica will produce pain that radiates beyond the knee.
- often a patient will have a previous history of lower back pain beginning a few days or weeks before the leg pain occurs, then the leg pain becomes worse than the back pain, and in some cases the back pain will completely disappear
However, in the case of longstanding history of sciatica, the pain may gradually become localized to the buttocks and back of the leg.
In this situation, the patient may have a vague aching pain that does not reach all the way to the lower leg or foot, though it may have done so earlier in the course of the disease. Often there is not a specific traumatic event or motion associated with the onset of sciatica.
Pain aggravating situations include:
Lying down is usually the most comfortable position. Occasionally paresthesias, weakness and diminished bowel or bladder function will accompany sciatica, but these are rare symptoms.
Diagnosis of Sciatica
A thorough history and physical examination is an important part of the diagnosis of sciatica.
Imaging tests performed to diagnose sciatica include:
- X-rays that reveal an overgrowth of bone (bone spur) that may be pressing on a nerve.
- MRI, a procedure that produces detailed images of bone and soft tissues such as herniated disks.
- CT scans, for a thorough inspection of the spinal canal.
- Electromyography (EMG) can confirm nerve compression caused by herniated disks or narrowing of the spinal canal (spinal stenosis).
Nerve root tension tests can be used to confirm the presence of sciatica by attempting to reproduce the discomfort with certain motions and body positions. These tests are performed by a doctor and involve moving the legs in certain ways that slightly stretch the sciatic nerve. If the patient experiences pain during these tests, an irritated sciatic nerve is likely to be a source of the pain.
Risk factors for sciatica include:
- Age (herniated disks and bone spurs are age-associated changes in the spine, and are also among the most common causes of sciatica)
- Degenerative arthritis of the lumbar spine
- Diabetes (a condition known to increase the risk of nerve damage)
- Genetics (inherited spine conditions)
- Lumbar disc disease
- Menopause (menopause can pose as risk factor due to its probability to lead to bone loss)
- Obesity (excess weight can increase the stress on the spine and thus trigger sciatica)
- Physical activities (any sports or jobs that requires back twisting, heavy load lifting, long-term driving or similar activities may play a role in sciatica development)
- Prolonged sitting (compared to an active lifestyle, a sedentary lifestyle is more likely to lead to the development of sciatica)
Causes of Sciatica
Sciatica may result from inflammation, irritation, or compression of the sciatic nerve or nerve root. The most common cause for sciatica is intervertebral disc damage in the lumbar or sacral region of the spine (the lower back). Intervertebral disc damages include:
Other causes include:
In rare cases, sciatica may be caused by:
Acupuncture
By stimulating vital energy flow and improving nerve function, acupuncture may be used as an alternative treatment therapy for sciatica. Always consult your physician at Cedars-Sinai Marina del Rey Hospital for the suitability of this option in your specific case.
Alternate Temperatures
To gain access to the deeper inflammation areas, ice packs are sometimes applied alternatively with hot packs or hot baths. Alternate temperatures are known to:
Chiropractic Adjustments
Despite the fact that scientific results do not back up the efficacy of chiropractic adjustments in each case, they can significantly reduce sciatic pain. Chiropractic manipulation of the spine may restore mobility and promote natural healing by:
Epsom Salt Bath
Epsom salts can be easily found in local drug stores, and are known to:
Ice Packs
Ice packs are great instant pain relievers and work great as short-term therapy options. Ice packs should be applied to the affected area, for a period between 20 minutes and two hour, or until pain disappears.
Massage
Deep tissue massage or trigger-point therapy may have beneficial effects in the case of muscle spasms, pain, and leg and toe numbness.
Mild Stretches, Including Yoga
Though sciatic pain may kill the desire for any type of movement, our physicians at Cedars-Sinai Marina del Rey Hospital recommend controlled physical activity to ease symptoms. This is because physical inactivity may actually aggravate the sciatic problem. Recommended physical activity such as gentle back stretches and mild yoga exercises may:
Tennis Ball Therapy
Tennis ball therapy combines the principles of massage, acupressure and reflexology to help relieve sore muscles and muscle tension. In sciatic pain, tennis ball therapy is used to apply pressure and treat trigger points in the piriformis muscle. Effects include:
For detailed information on tennis ball therapy or other available sciatic treatment options, please contact our well-prepared medical specialists at Cedars-Sinai Marina del Rey Hospital.
Though genetic and lifestyle factors may increase the risk of sciatica development, focused attention on small lifestyle changes may prevent the condition from occurring. These lifestyle changes include:
- Correct lifting. Learning and following the correct method for lifting and moving objects will help prevent sciatica.
- Correct posture while sitting and standing, driving and sleeping.
- Regular exercise such as walking, swimming, cycling, etc. Age is strong risk factor for sciatica. Regular exercise will help maintain muscle strength, keep joints well lubricated – meaning that it will work as an anti-aging solution for the body.
- Specific diagnosis
- Taking breaks and micro-breaks every 30 minutes or every hour, especially in the case of jobs that require long-term sitting. Taking short breaks and allowing the legs to stretch and move will work wonders in long-term prevention.
Should you experience lower back pain, lower leg pain or any other sciatica symptoms, do not hesitate to contact our knowledgeable, qualified professionals at Cedars-Sinai Marina del Rey Hospital.
