Sciatica: An Introduction

Only a trained physician can differentiate between the many causes of sciatica and without an accurate diagnosis, effective therapy is just a crapshoot. Don’t gamble with your back pain. See a professional!

Sciatica is one of the most common back pain syndromes. The primary pain in sciatica is usually described as starting in the lower back and then traveling either part way or all the way down the leg, although on occasion sciatica can present as either pure back pain or pure leg pain. The pain is usually described as burning, electrical or lancinating. One characteristic of sciatica is that it is constantly changing in intensity and moving in location. Sciatica can be caused by a number of different conditions at different times in a person’s life.

The most common cause for sciatica among younger and middle aged individuals is lumbar disc disease and can result from either disc protrusions or frank herniations. Presentation is sometimes sudden in younger individuals but is more often gradual in middle aged and older patients. Also as patients get older they become increasingly likely to suffer from boney or arthritic abnormalities, such as spondylolisthesis (slipped vertebrae), spinal stenosis or foramenal stenosis.

Differentiating between the different causes of sciatica is not simply medical hair-splitting. While many can be treated with similar steroid injections, when these injections fail to provide complete relief the surgical therapies vary considerably. For instance, lumbar disc disease in a younger individual is likely to be limited to a single disc and perhaps even a single side of a single disc. This type of disc problem can be amenable to treatment by a minimally invasive procedure like a micro-lumbar discectomy. Such a procedure can often be done on an outpatient basis, has a relatively short and easy recovery period and carries with it a very high rate of success. On the other hand, spinal stenosis in an older individual is likely to extend over several segments and involve both sides of the spine. A multilevel lumbar decompression will probably require several days in the hospital, a recuperation period of several months and a significant chance of residual pain both from the surgery and perhaps postoperative scarring. In cases involving spondylolisthesis where the spine is potentially unstable, the magnitude of the surgical endeavor is even larger with attendant increases in risk and pain.

So what is one to do? Here is where a full service, multispecialty pain clinic can be extremely helpful. We at Schlesinger Pain Centers over the years have developed a facility with the art of helping patients evaluate the risks of both surgical and non-surgical treatment. We can help you decide when such risks are warranted and when another course of action may in fact be better.

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