Sciatica is pain that radiates from the lower back along the sciatica nerve. Sciatica is a type of lumbar radiculopathy; a condition described as pain and/or sensations (eg numbness, tingling) that travels downward into one or both legs. Pain is the hallmark sciatic 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 associated left or right leg. The sciatic nerve has several smaller nerves that branch off from the main nerve and enable movement and feeling (motor and sensory functions) in the thighs, knees, calves, ankles, feet, and toes.
4 Facts About Sciatica Pain and Symptoms
- Sciatica symptoms may begin gradually or suddenly.
- Pain is characterized as being sharp, shooting or electric shock-like.
- Movement, such as walking can intensify pain.
- Sometimes pain feels uniformly distributed through the leg, but frequently some areas of the leg may be more painful.
Where Sciatica Starts, How Sciatic Pain Travels
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.
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. The muscular branch serves the leg flexor muscles (muscles that enable movement).
Other complex nerve structures are involved—the peroneal nerves and tibial nerves. The peroneal nerves originate from the nerve roots at the fourth and fifth lumbar spine (L4-L5) and first and second levels of the sacrum (S1-S2). After the peroneal nerves leave the pelvis, they travel down the front and side of the legs, and along the outer side of the knees, to the feet.
The tibial nerves originate from the nerve roots at L4-5 and S1-3. The tibial nerves pass in front of the knees and downward into the feet (eg, heels, toes).
What can cause sciatica symptoms to develop?
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).
Is surgery necessary to relieve sciatica symptoms?
Most patients with sciatica symptoms or lumbar radiculopathy respond well to non-surgical treatments, such as medication and physical therapy. Seldom is spine surgery required to treat sciatica. However, there are situations when spine surgery is recommended.
- Bowel and/or bladder dysfunction (rare)
- Severe leg weakness
- Non-surgical treatments are not effective, or no longer reduce sciatic symptoms
What type of spine surgery may be recommended to treat the cause of sciatica?
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.
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).
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).