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Cascade Orthopaedics Practice Newsletter |
Thanks for being a patient of Cascade Orthopaedics! While many patients visit us for a specific problem, they or their loved ones often have other unrelated orthopaedic concerns. We are producing a monthly newsletter with the intent to provide a source of information and to serve as an educational resource for our patients on some common problems, and give advice on maintaining musculoskeletal health. Our goal is to help you prevent problems, and recognize what conditions might be causing pain and disability. We may also suggest resources that might be available to help you prevent or manage problems. Cascade's Website
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SCIATICA
 | | Figure A |
Sciatica is the term for low back pain that radiates into the buttock, hip, and down one leg to the foot (refer to Figure A). The pain often is associated with tingling, numbness, or weakness of the leg. It may be sudden in onset and can persist for days or weeks. Sciatica can be caused by a number of conditions that lead to compression or irritation of nerves as they exit the spinal canal(space through which the spinal cord travels) in the region of the lower back where they come together to form the sciatic nerves at the end of the spinal column. People who get sciatica are usually between the ages of 30 and 50 years. Approximately 80% to 90% of people with sciatica recover over time without any surgical intervention.
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CAUSES:
 | | Figure B |
- The most common cause of sciatica occurs when the gel-like center of the disk between the vertebrae (bones that make up the spine) protrudes into or through the disk's outer lining (refer to Figure B). This is called a herniated disk, which leads to compression of individual nerves in the lower back where they branch off from the spinal cord or to compression of the sciatic nerve itself. This form of sciatic nerve injury is called radiculopathy.
- Degenerative arthritis due to wear and tear of the vertebral bones. This can lead to spinal stenosis (narrowing of the spinal canal), which may compromise nerves as they exit the spinal canal.
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Piriformis Syndrome is when the piriformis muscle (located deep in the buttock) is in spasm and can pinch the sciatic nerve as it passes under or through the piriformis muscle. Refer to the picture below (Figure C).
 | | Figure C |
- Vascular problems due to abnormalities of blood vessels in and around the spinal canal.
- Rarely, tumors may occur inside the spinal cord, within the meninges (linings around the spinal cord), or in the spaces between the vertebrae and the spinal cord. Growth of a tumor may cause compression of the spinal cord and the nerves coming from it.
- Other causes such as trauma, infection, and inflammation can affect nervous tissue.
- Pregnancy may cause irritation of the sciatic nerve from pressure of the head or body of the fetus.
DIAGNOSIS:
A complete history is required as well as a physical examination to determine the location of the irritated nerve root.
 | | Figure D |
X-rays are rarely needed since they cannot detect a herniated disk. X-rays can show evidence of spondylolisthesis (misalignment of the vertebrae--refer to Figure D), narrowed disks, or evidence of erosion.
Magnetic Resonance Imaging (MRI) produces images that allow visualization of the vertebral disks, ligaments, and muscles, as well as the presence of tumors (refer to Figure E).
Computed Tomography (CT) myelography using contrast dye injected into the spine allows visualization of the spinal cord and nerves.
Electromyography Study (EMG/NCV) is a nerve study that assesses which nerve(s) may be injured, how severe it is injured, how long it has been injured for, and the prognosis for recovery (refer to Figure F).
 | | FigureE |
 | | Figure F |
TREATMENT:
Analgesics for pain include over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs--such as ibuprofen), opiate pain medications, muscle relaxants, and nerve pain medications.
Occasionally a physician may prescribe steroid medications for the pain or give X-ray guided spinal injections of a steroid medication (Epidural Steroid Injections) to help reduce the inflammation that accompanies sciatica pain.
Physical therapy or Massage therapy to help relieve the pain and correct postural problems that cause or aggravate the pain.
Surgery, when analgesics, steroid medications/injections, physical/massage therapy have not resulted in symptom relief, or if weakness in the legs or bladder and bowel incontinence occurs.
If you have symptoms of sciatica that are not relieved by initial rest (no more than 2 days of bed rest is recommended), over-the-counter NSAIDs, or if you are developing progressive symptoms of leg numbness or weakness, you may consult your primary care physician or obtain an evaluation with one of our spine specialists at Cascade Orthopaedics. You may call our office at 253-833-7750 to determine if your insurance requires a referral. If you are having bowel or bladder incontinence, you may be having symptoms of Cauda Equina Syndrome, which is considered a medical emergency, and you should seek immediate evaluation at an Emergency Room.
This material presented is for educational and informational purposes only. You should consult a physician or health care provider for actual evaluation, diagnosis, and individual treatment recommendations or advice.
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