Sciatica

Sciatica occurs when there is damage to or pressure on the sciatic nerve, which causes nerve pain. The sciatic nerve starts in the low back and runs down the back or side of the leg.

Sciatica symptoms include a burning or tingling pain that extends from the low spine down the back or side of the leg. It is frequently worse after sitting.

Causes of Sciatica

Causes of sciatica include the following:

• Herniated disc
• Spinal tumor
• Spinal stenosis
• Pelvic fracture

When to Get Help for Sciatica?

Call your primary care doctor if you experience any of the following:

• Loss of bowel or bladder control with the pain
• Pain that is worse when you cough or sneeze
• Pain that wakes you up during sleep
• Numbness or weakness in your legs
• Pain not relieved within a couple weeks by rest, ice or heat, or over-the-counter medications

Care for Sciatica at Rush

If your primary care doctor recommends you receive further testing and evaluation to determine the cause of your sciatica, Rush has specialists who can help.

Different types of back pain require different treatments. Stretches that relieve one kind of pain could intensify another. Rush spine and back, pain medicine or physical medicine and rehabilitation specialists can help you identify the right approach.

Nonsurgical Treatments

Surgery is rarely used as an initial treatment for sciatica. Our experts will first try nonsurgical methods to relieve your sciatic nerve pain, including the following:

• Stretching or physical therapy
• Medication (taken by mouth)
• Spinal injections (commonly called epidural steroid) of pain-relieving medication directly to the source of your pain, with image guidance to ensure precise needle placement
• Nutritional and exercise guidance if extra weight is contributing to your sciatica
• Alternative therapies, like yoga, massage, biofeedback, and acupuncture

Interventional Treatment

• Intrathecal pump, delivers low doses of pain-relieving medication directly into your spinal cord. You'll have fewer side effects than with oral pain medication because the pump uses lower doses.

Surgical Treatments

If your sciatica does not respond to nonsurgical treatments, surgery to address the underlying medical condition may be your best option.

Depending on what's causing your sciatic pain, your surgeon may recommend the following procedures for you, alone or in combination:

• Discectomy, or microdiscectomy, a minimally invasive procedure to remove part of a spinal disc. It may be a good option if your sciatica is caused by a herniated lumbar disc. At Rush, discectomy is typically performed as an outpatient procedure and often does not involve a hospital stay.
• Laminectomy, used to create more space for the nerves by removing the lamina (or roof) of one or more vertebrae. Like discectomy, laminectomy is typically used to treat sciatica pain caused by lumbar spinal stenosis.
• Foraminotomy, removes pressure from a nerve root by removing a small portion of bone around the affected nerve root. This may be performed by itself or in combination with a laminectomy or a discectomy.
• Facetectomy, used to relieve compression on pinched nerves caused by degenerated (worn down) facet joints. With this procedure, your facet joints are trimmed or removed to relieve pressure on the nerves.
• Spinal fusion, a surgery in which two or more of your vertebrae are permanently joined together. Whenever possible, spine surgeons at Rush perform spinal fusions using minimally invasive approaches that help you heal faster and with less pain.
• Spinal cord stimulation, involves blocking transmission of pain signals from the spine to the brain. It may be a good option if you have chronic sciatic pain, including pain that persists after one or more spine surgeries (this is known as failed spine surgery syndrome). Your doctor can implant the stimulator using only a small incision.

Rush Excellence in Sciatica

• Comprehensive nonsurgical sciatica care: You may be putting off seeing a doctor for your sciatica because you're afraid of having surgery. But our experts can often effectively treat sciatica or delay the need for surgery with conservative approaches such as injections, spinal cord stimulators and physical therapy. We may also recommend lifestyle changes such as exercise, diet modifications and quitting smoking to improve both symptoms and your overall health.
• Less invasive spine surgery: Spine surgeons at Rush offer an extensive range of minimally invasive techniques. These techniques enable you to have a major back procedure like a lumbar discectomy with an incision smaller than a paper clip. That means you will typically experience less pain, a shorter hospital stay and a quicker recovery.
• Nationally recognized programs: U.S. News & World Report ranked Rush University Medical Center among the best hospitals in the nation for neurology and neurosurgery and for orthopedics.