Sciatica and Sciatic Nerve Pain

Sciatica is a lumbar spine condition that won't stay in the spine. It's a pain in the butt...literally.

Sciatica starts in the lower back. Nerve roots in the lumbosacral spine eventually come together and turn into the sciatic nerve in the buttocks. Sciatica happens when these nerve roots become compressed, often from a herniated disc or a narrowing of the spinal canal called stenosis.

What Are Common Sciatica Symptoms?

This nerve impingement causes sciatic nerve pain that radiates from the lower back down the leg. Sciatica is a type of lumbar radiculopathy; a condition described as pain and/or sensations such as numbness or tingling that travel down into one or both legs. Pain is the hallmark sciatica symptom, and classic sciatica radiates below the knee.Typically, sciatica causes pain, numbness and/or tingling in one side of the lower back and the same side leg.

Illustrationof the sciatic nerve and pain distributionLeg pain that descends below the knee is the classic hallmark of sciatica, a type of lumbar radiculopathy. Photo Source:

What Is the Sciatic Nerve?

The sciatic nerve is the longest and largest nerve in the body; its diameter is about three-quarters of an inch. It originates in the sacral plexus; a network of nerves in the lower back (lumbosacral spine). The lumbosacral spine refers to the lumbar spine (lumbo) and the sacrum (sacral) combined, way down at the base of your spine and above the tailbone (coccyx).

The sciatic nerve exits the sacrum (pelvic area) through a nerve passageway called the sciatic foramen. At the upper part of the sciatic nerve, two branches form; the articular and muscular branches. The articular branch goes to the hip joint (articular means related to a joint). The muscular branch serves the muscles of the leg.

The sciatic nerve has several smaller nerves that branch off from the main nerve. These nerves--the peroneal and tibial nerves--enable movement and feeling (motor and sensory functions) in the thighs, knees, calves, ankles, feet, and toes.

What Causes Sciatica?

Sciatic nerve compression causes sciatica symptoms sometimes referred to as a lumbar or low back radiculopathy. Common sciatica causes include disorders affecting the lumbar spine, such as herniated disc, degenerative disc disease, osteophytes (bone spurs) or spinal stenosis. Rarely does a spinal infection or tumor cause sciatica symptoms.

Can Over-the-Counter Medications Help Relieve Sciatica Symptoms?

Under a doctor or healthcare provider’s advice, over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs) may help reduce swelling and sciatic pain. There are many types of OTC medication, such as acetaminophen (eg, Tylenol), ibuprofen (eg, Advil), or naproxen (eg, Aleve).

Do You Need Sciatica Surgery?

Most patients with sciatica symptoms or lumbar radiculopathy respond well to non-surgical treatments, such as medication, exercise and special sciatica stretches, and physical therapy. Seldom is spine surgery required to treat sciatica.

However, there are situations when surgical sciatica treatment is recommended.

  • Bowel and/or bladder dysfunction (rare)
  • Severe leg weakness
  • Non-surgical sciatica treatment is ineffective or no longer reduces sciatica pain

For the right patient, surgery can be very effective. A small 2020 study in New England Journal of Medicine compared surgery to physical therapy for sciatica due to a herniated disc. On average, the patients who had surgery reported much lower pain levels than the people who underwent PT only. 

What Type of Sciatica Surgery Do I Need?

The type of surgery recommended depends on the diagnosis, number of spinal levels requiring treatment and surgical goals. Spinal decompression is a procedure the spine surgeon performs to remove whatever is pressing on the sciatic nerve—such as a disc herniation. Many patients are able to undergo decompression surgery in an outpatient or ambulatory spine center without being hospitalized. Also, many surgical procedures can be performed minimally invasively.

Discectomy, Microdiscectomy
Traditional discectomy is performed open, meaning through a long incision whereas microdiscectomy is the same procedure performed minimally invasively through tiny incisions. During either procedure, the surgeon removes the entire disc or the portion of the disc compressing nerve(s).

Laminotomy, Laminectomy
Both procedures involve a part of the spine called the lamina—a thin bony plate that protects the spinal canal. The lamina is located at the back or posterior spine between two vertebral bodies. The difference between these procedures is the amount of lamina removed to access bone, disc or other soft tissue compressing spinal nerve roots.

  • Laminotomy involves partial removal of the lamina.
  • Laminectomy involves total removal of the lamina.

By partially or entirely removing a lamina, the surgeon can access the bulging or herniated disc from the posterior spine. Of course, the surgeon may remove other tissue (eg, bone spur) pressing on a spinal nerve root at a particular spinal level (eg, L4-L5).

Sciatica symptoms? Find a spine specialist near you who can help. 

Continue reading: Sciatica Symptoms and Causes

Updated on: 05/12/20
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