Sciatica: Inflammation, Causes, and Surgical Intervention

What is Sciatica?

Sciatica, or sciatic nerve pain, is an inflammation of the sciatic nerve. Originating from the lower lumbar nerve roots L4, L5, and S1, it travels through various muscles, crosses the pelvis, and runs down the thigh to the back and sole of the foot. The sciatic nerve is responsible for innervating the entire leg.

What does Sciatica Feel Like?

Sciatica is characterized by intense, debilitating pain in the back, buttock, and leg – pain that is difficult, if not impossible, to ignore. This condition affects more men than women.

How is the Sciatic Nerve Affected?

Sciatica typically occurs when a nerve is compressed in the lumbar region of the spine. Medically, this is referred to as lumbar radiculopathy or radicular pain, describing symptoms caused by nerve compression in the spine. Understanding these symptoms requires considering several factors. Symptoms vary depending on the nerve affected and the severity of the compression. In various lower back conditions, intense pain can radiate and impact the sciatic nerve. This pain is usually caused by the irritation of a herniated disc at the L5 or S1 nerve root at the base of the spine. The nerve roots extending from the spine to form the sciatic nerve are highly sensitive. The inner part of the disc contains inflammatory proteins that can easily cause a herniation and irritate the nerve. When this happens, intense pain radiates down the lower back, thigh, and calf, potentially extending to the foot.

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What are the Symptoms and Causes of Sciatic Nerve Compression?

Symptoms of Sciatic Nerve Compression

To better understand the pain caused by the sciatic nerve in the legs, here are the most frequently observed symptoms:

• It occurs in one leg (not both);
• It begins in the back or buttock and radiates down the back of the thigh and usually into the lower leg and/or foot;
• It's usually felt as sharp pain. Words patients often use to describe sciatic nerve pain are "burning," "aching," or "pain like electric shocks";
• It usually worsens when you get up or sit down again and improves when you lie down or walk;

Besides pain, other common symptoms include pressure, numbness, tingling, or a pins-and-needles sensation radiating down the leg. Leg or foot weakness may also be present. Sciatica is actually a symptom, not a diagnosis. The term literally means a patient suffers from leg pain resulting from compression of the sciatic nerve. The diagnosis focuses on the cause of the compression.

Causes of Sciatic Nerve Inflammation

Many situations, traumas, and conditions can cause sciatica:

• Maintaining poor posture for extended periods;
• Sedentary lifestyle and inactivity, even in the presence of pain;
• Narrowing of the foraminal and spinal canal;
• Conditions such as spinal tumors, herniated discs, etc.;

The most frequent predisposing factors are:

• Diseases such as arthritis, diabetes, osteoporosis;
• Spinal infections;
• Leg injuries, cold drafts, spinal overload;
• Pregnancy, overweight;
• Advanced age;
• Stress;

What are the Different Types of Pain Associated with the Sciatic Nerve?

L4 Nerve Root Sciatica.

Let's examine the signs of sciatica caused by the area at the L3-L4 level of the lower spine. These may include: pain and/or numbness in the leg and foot, as well as weakness that may lead to an inability to bring the foot forward. The patient may have a diminished knee reflex.

L5 Nerve Root Sciatica

If the L4-L5 segment is affected, the patient may experience weakness in foot extension and potentially in the ankle. Symptoms of sciatica from this level of the back may include: pain and/or numbness on top of the foot, particularly in the space between the big toe (hallux) and the second toe.

S1 Nerve Root Sciatica

Symptoms of sciatica originating from this L5-S1 level, located at the bottom of the spine, may include: pain and/or numbness in the lateral or outer part of the foot; weakness resulting in difficulty lifting the heel off the ground or walking on the toes. The patient may have a diminished ankle reflex.

When is Surgery Necessary?

Surgical intervention for sciatica is often recommended when it's accompanied by neurological deficits or persists for more than 4 to 5 weeks without responding to medication. The goal of surgery is to eliminate the inflammation causing the sciatica, such as a herniated disc or disc degeneration. Although there are percutaneous techniques to treat herniated discs, most neurosurgeons prefer the traditional method involving an incision in the skin and underlying tissues to directly access the herniated disc and the affected nerve root.

For effective management of sciatica from its first symptoms, targeted drug therapy, including anti-inflammatory drugs, muscle relaxants, and analgesics, is essential. Rest is also crucial, while wearing a back brace may benefit some patients. Once the pain has subsided, physiotherapy sessions or treatments such as medical laser therapy can be very helpful.