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Dr Yu Chao Lee

Sciatica

Sciatica occurs when spinal nerves are compressed. This results in pain that radiates from the back, into the legs, and occasionally the feet.

Early medical review is important to allow accurate diagnosis and timely implementation of treatment to prevent prolonged suffering.

The common signs and symptoms of sciatica are:

  • Pain that radiates down the buttocks and thighs, often beyond the knees
  • Numbness or tingling in the legs

 

Please seek urgent medical attention if you have any of the following:

  • Numbness in your genital area
  • Difficulty controlling bowels
  • Difficulty controlling urination
  • Weakness of legs or feet

The most common cause for sciatica is lumbar disc herniation. A herniated disc may result from long standing wear and tear, or a sudden injury. This causes the central part of the disc to be pushed through the outer layer, causing a bulge and pressing on nearby nerves.

Another potential cause for sciatica is foraminal stenosis. This is the narrowing of the channel in which spinal nerve exit from the spinal column. Foraminal stenosis is also commonly due to wear and tear (lumbar degeneration).

Your doctor can make the diagnosis of sciatica by asking questions about your symptoms and by performing a physical examination that tests sensation, muscle strength, and reflexes.

An MRI is used to confirm a herniated disc or foraminal stenosis. Plain X-rays of the spine or CT scan may also help to assess your spinal alignment and assess for bony spurs that may contribute to spinal nerve compression.

The majority of patients with sciatica respond to conservative therapy such as medication and physical therapy.

Medications: Nonsteroidal anti-inflammatory medications (NSAIDs) are commonly prescribed, to reduce the inflammation and to relieve pressure around the compressed nerves.

Phyiscal therapy: Avoid activities that may worsen your symptoms such as lifting. It is important to remain active. Prolonged bed rest can cause muscle stiffness and wasting. Your doctor or physiotherapist may suggest exercises to keep the back muscles strong and help protect against future injury.

Your doctor may also recommend an epidural steroid injection. This is targeted at the area of nerve compression, to reduce inflammation around the nerve and help with sciatica pain.

Surgery may be considered only after conservative therapy fails to adequately relieve the symptoms over a substantial period of time. For disc herniation, a partial microdiscectomy, may be performed to remove the protruding portion of the disc. In some cases spinal reconstruction may be performed for patients with foraminal stenosis.



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