Sciatica is painful, but you don’t always need surgery

Suddenly you feel a sharp pain or a tingling down the back of your thigh. Your first thought is that it’s a strained muscle from that tennis game, a recent hike or because you lifted something too heavy.

If you are in your 30’s or 40’s, chances are you have a herniated a disc. But if you’re over 50, the pain, weakness or tingling you feel in the back of your leg is probably from sciatica, a condition arising from damaged nerves in the lower spine.

“Sciatica is one of the most common problems we see in the office,” said neurosurgeon Gordon Nakata, MD, who practices at Cape Cod Hospital. “Older people are more likely to have it than younger ones. As we age, we lose water and the insulating properties of soft tissue in our joints, and that puts stress on the bones.”

Typically that happens when the second lowest vertebra in the spine (in medical lingo, the L4) slips or grinds into the lowest one (the L5) and puts pressure on the nerve root. The sciatic nerve runs down each side of the body from the lower spine into the buttock, to the back of the thigh and down to the foot, which explains the radiating pain that sufferers often feel all the way down the back of the leg.

In addition to pain, the pressure the L4 vertebra places upon L5 creates bone spurs.

“You can’t see or feel those spurs from the outside of your back because they are buried deep inside your skin. But the grinding of those vertebrae makes them jut out and look like spurs,” Dr. Nakata explained.

Don’t Panic – You Usually Don’t Need Surgery

Usually sciatic pain can be relieved with a few days’ rest and over-the-counter painkillers. If the pain continues for more than a week, you should seek medical advice, said Dr. Nakata.

“Get to your primary physician or a neurosurgeon, but don’t assume you’ll need surgery. In most cases, there are other options before we consider that,” he said.

Initially, neurosurgeons treat sciatica conservatively with a regimen of rest and medications. If that fails to resolve the pain, the next step is a steroid injection in the spine, followed by sessions with a physical therapist. Depending upon the severity of the case, other recommendations include visits to a chiropractor or treatments with acupuncture.

Sciatic pain usually resolves within a few weeks with these treatments, but there are exceptions.

“Sometimes the pathology is so severe that we immediately recommend surgical intervention,” said Dr. Nakata, who often consults with the Cape Cod Pain Center across the hall from his Hyannis office.

Surgery is also recommended for patients so impaired by pain that they have trouble walking or they cannot walk at all. Patients in the workforce may also elect surgery because they cannot take weeks off to allow time for more conservative treatments to take effect.

During the operation, the neurosurgeon creates a small incision in the lower back through which he inserts an endoscope or arthroscope. Another instrument is threaded through that scope to shave down the bone spur or remove a herniated disc.

“In the old days surgery meant lying in bed for two weeks, but with today’s technological advances, patients are back on their feet much quicker,” said Dr. Nakata.

While people sometimes mistake neuropathy for sciatica, its symptoms are different and are usually experienced as a burning sensation down the back of the leg. Occasionally too, radiating pain down the back of the leg may come from a tumor sitting on a nerve or from complications of diabetes.

Although sciatica tends to occur in older people, good health practices can go a long way towards mitigating it.

“Good posture, keeping your weight down, regular exercise and keeping a strong core can help,” Dr. Nakata said. “Remember, when you slouch forward you take the pressure off your joints and place it on your lower spine. If you haven’t had good posture earlier in life, it may be hard to make up for it now, but it’s important to try.”