Sciatica And Low Back Pain Specialist

Sciatica And Low Back Pain Q & A

Sciatica and Low Back Pain

Sciatica refers to pain that is characterized by radiating pain from lower back and buttock region along the path of the sciatic nerve coursing through buttock/hips, down the leg up to the foot region. It is often characterized with other symptoms such as numbness, tingling and motor strength weakness. The most common condition that causes sciatica is a bulging disc in the lumbar region, also sometimes referred to as herniated disc that pinches the nerve resulting in swelling and inflammation of the nerve.

Evaluation: A detailed pain history with onset, provocative maneuvers/factors, quality, radiation, site, other associated symptoms, and time course is the most important thing for an initial evaluation. Pertinent family history such as rheumatological disease and other past medical history could also help narrow down the diagnosis.

Physical examination such as a thorough focused lumbar exam, gait assessment, pelvis exam and neurological exam can help narrow down on the differential diagnosis.

Radiographic evaluation such as plain x-rays are generally considered first line. Advanced imaging such MRIs can help substantiate diagnostic secondary to a disc herniation, pinched nerve due to arthritis, or vertebral column instability commonly known as spondylolisthesis, etc.

Causes of Low Back Pain
  1. Nonspecific mechanical back pain accounts for 80% of the cases of adults with low back pain.
  2. Approximately 15% of the patient with back pain will have conditions related to degenerative disc disease and degenerative arthritis of the spinal joints. These include disc herniation/bulge, spinal stenosis, spondylosis, sacroiliitis etc. The symptoms associated with primary spinal degenerative pathology include lumbar radiculopathy, lumbosacral radiculopathy also known as sciatica, and axial low back pain.
  3. Approximately 4% of patients with low back pain will have a vertebral compression fracture.
  4. Less than 1% will have a serious medical condition such as metastatic cancer, spinal infection, cauda equina syndrome, etc.

Laboratory testing may be indicated for conditions that raise suspicion after a thorough history and physical examination. These conditions include rheumatological disease, discitis, metastatic cancer, etc. Lab testing may include CBC, C-reactive protein, ESR, rheumatoid factor, HLA B 27, antinuclear antibodies etc.

Imaging: Plain radiographs such as x-ray should be performed in acute low back pain to exclude fracture, and to assess for spinal instability secondary to spondylosis and spondylolisthesis. MRI or CT may be necessary when history, physical exam findings and plain radiographs are inconclusive.

Treatment
  1. Conservative treatment modalities include rest, ice, over-the-counter anti-inflammatory medications such as ibuprofen, Aleve, Tylenol, prescription muscle relaxants, oral steroids for severe pain etc. Physical therapy and chiropractic treatments are generally considered in combination with medications.
  2. Diagnostic and corticosteroid injections can be tried after failure of conservative modalities and ongoing severe pain secondary to lumbar radiculitis, sciatica, facet joint arthropathy (spondylosis), spinal stenosis, SI joint dysfunction/sacroiliitis. These include epidural steroid injections, SI joint injections, Facet joint injections, Radiofrequency ablation, etc.
  3. Vertebral augmentation/kyphoplasty can be considered for non-metastatic vertebral compression fractures if there is failure of response to conservative management.
  4. Surgical treatment includes minimally invasive discectomy, laminectomy/laminotomy and spinal fusion.

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