What causes sciatica? 4 possible conditions
Your sciatic nerve begins at your spinal cord, runs through your hips and buttocks, and then branches down each leg. This nerve is your body’s longest nerve and one of the most important ones. It also has a direct effect on your ability to control.
1. Slipped (Herniated) Disk
Part 1:
What is a slipped disk?
Your spinal column is made up of a series of bones (vertebrae) stacked onto each other. From top to bottom, the column includes seven bones in the cervical spine, 12 in the thoracic spine, and five in the lumbar spine, followed by the sacrum and the coccyx at the base. These bones are cushioned by disks. The disks protect the bones by absorbing the shocks from daily activities like walking, lifting, and twisting.
Each disk has two parts: a soft, gelatinous inner portion and a tough outer ring. Injury or weakness can cause the inner portion of the disk to protrude through the outer ring. This is known as a slipped, herniated, or prolapsed disk. This causes pain and discomfort. If the slipped disk compresses one of your spinal nerves, you may also experience numbness and pain along the affected nerve. In severe instances, you may require surgery to remove or repair the slipped disk.
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Part 2:
What are the symptoms of a slipped disk?
You can have a slipped disk in any part of your spine, from your neck to your lower back. The lower back is one of the more common areas for slipped disks. Your spinal column is an intricate network of nerves and blood vessels. A slipped disk can place extra pressure on the nerves and muscles around it.
Symptoms of a slipped disk include:
The types of pain can vary from person to person. See your doctor if your pain results in numbness or tingling that affects your ability to control your muscles.
Part 3:
What causes slipped disks?
A slipped disk occurs when the outer ring becomes weak or torn and allows the inner portion to slip out. This can happen with age. Certain motions may also cause a slipped disk. A disk can slip out of place while you are twisting or turning to lift an object. Lifting a very large, heavy object can place great strain on the lower back, resulting in a slipped disk. If you have a very physically demanding job that requires a lot of lifting, you may be at increased risk for slipped disks.
Overweight individuals are also at increased risk for a slipped disk because their disks must support the additional weight. Weak muscles and a sedentary lifestyle may also contribute to the development of a slipped disk.
As you get older, you are more likely to experience a slipped disk. This is because your disks begin to lose some of their protective water content as you age. As a result, they can slip more easily out of place. They are more common in men than women.
Part 4:
How are slipped disks diagnosed?
Your doctor will first perform a physical exam. They will be looking for the source of your pain and discomfort. This will involve checking your nerve function and muscle strength, and whether you feel pain when moving or touching the affected area. Your doctor also will ask you about your medical history and your symptoms. They will be interested in when you first felt symptoms and what activities cause your pain to worsen.
Imaging tests can help your doctor view the bones and muscles of your spine and identify any damaged areas. Examples of imaging scans include:
Your doctor can combine all these pieces of information to determine what is causing your pain, weakness, or discomfort.
Part 5:
What are the complications of a slipped disk?
An untreated, severe slipped disk can lead to permanent nerve damage. In very rare cases, a slipped disk can cut off nerve impulses to the cauda equina nerves in your lower back and legs. If this occurs, you may lose bowel or bladder control.
Another long-term complication is known as saddle anesthesia. In this case, the slipped disk compresses nerves and causes you to lose sensation in your inner thighs, the back of your legs, and around your rectum.
While the symptoms of a slipped disk may improve, they also can worsen. If you cannot perform the activities you once could, it’s time to see your doctor.
Part 6:
How are slipped disks treated?
Treatments for a slipped disk range from conservative to surgical. The treatment typically depends on the level of discomfort you’re experiencing and how far the disk has slipped out of place.
Most people can relieve slipped disk pain using an exercise program that stretches and strengthens the back and surrounding muscles. A physical therapist may recommend exercises that can strengthen your back while reducing your pain.
Taking over-the-counter pain relievers and avoiding heavy lifting and painful positions can also help.
While it may be tempting to refrain from all physical activity while you’re experiencing the pain or discomfort of a slipped disk, this can lead to muscle weakness and joint stiffness. Instead, try to remain as active as possible through stretching or low-impact activities such as walking.
If your slipped disk pain does not respond to over-the-counter treatments, your doctor may prescribe stronger medications. These include:
Your doctor may recommend surgery if your symptoms do not subside in six weeks or if your slipped disk is affecting your muscle function. Your surgeon may remove the damaged or protruding portion of the disk without removing the entire disk. This is called a microdiskectomy.
In more severe cases, your doctor may replace the disk with an artificial one or remove the disk and fuse your vertebrae together. This procedure, along with a laminectomy and spinal fusion, adds stability to your spinal column.
Part 7:
What is the outlook for someone with a slipped disk?
Most people with a slipped disk respond well to conservative treatment. Within six weeks their pain and discomfort will gradually lessen.
It may not be possible to prevent a slipped disk, but you can take steps to reduce your risk of developing a slipped disk. These steps include:
2. Spondylolisthesis
What Is Spondylolisthesis?
Spondylolisthesis is a spinal condition that affects the lower vertebrae (spinal bones). This disease causes one of the lower vertebras to slip forward onto the bone directly beneath it. This is a painful condition, but it is treatable in most cases. Both therapeutic and surgical methods may be used. Proper exercise techniques can help you avoid this condition.
Symptoms of Spondylolisthesis
The symptoms of spondylolisthesis vary. People with mild cases may not have any symptoms. However, people with severe cases may be unable to perform daily activities. Some of the most common symptoms are:
Causes of Spondylolisthesis
Causes of spondylolisthesis vary based on age, heredity, and lifestyle. Children may suffer from this condition as the result of a birth defect or injury. However, people of all ages are susceptible if the condition runs in your family. Rapid growth during adolescence may also be a contributing factor.
Playing sports may also cause your strain to overstretch and put stress on your lower back. The following sports are especially likely to cause this condition:
Spondylolysis is often a precursor to spondylolisthesis. Spondylolysis occurs when there is a fracture in a vertebra, but it has not yet fallen onto a lower bone in your spine.
Diagnosing Spondylolisthesis
Physical exams are the first step in diagnosing this condition. If you have spondylolisthesis, you may have difficulty raising your leg straight outward during simple exercises. X-rays of your lower spine are crucial for determining whether a vertebra is out of place. Your doctor may also look for any possible bone fractures on the X-ray images.
Your doctor may order a more detailed CT scan if the misplaced bone is pressing on your nerves.
Treating Spondylolisthesis
The treatment for spondylolisthesis depends on your severity of pain and vertebra slippage. Nonsurgical treatments can help ease pain and encourage the bone to go back into place. It’s important to avoid contact sports during the healing process.
Common nonsurgical treatment methods include:
The American Academy of Orthopaedic Surgeons recommends trying nonsurgical treatments first. However, adults suffering from severe cases of spondylolisthesis may need to have a spinal fusion. Surgical correction of the misplaced vertebra is required when the bone has slipped so far down that your spine doesn’t respond to nonsurgical therapies. Surgery is also required if the bones of your spine are pressing on your nerves.
Your doctor will work to stabilize your spine by using a bone graft and metal rods. They may insert an internal brace to help support the vertebra while it heals. After the spinal fusion is complete, it will take four to eight months for the bones to fully fuse together. The success rate of the surgery is very high.
Potential Complications
Medical intervention is crucial for relieving symptoms of spondylolisthesis. This condition can cause chronic pain and permanent damage if left untreated. You may eventually experience joint weakness and leg paralysis if nerves have been damaged. Infection of the spine may also occur in rare cases.
Kyphosis, also called roundback, is a complication in which the upper portion of the spine falls off of the lower half, causing increased forward spinal angulation.
Long-Term Outlook
Back pain can be scary, so it’s important to talk to your doctor as soon as you think you may have experienced symptoms of spondyloslisthesis. Early treatment measures can cure most cases of spondylolisthesis. According to an article published in Neurosurgical Focus, most people with spondylolisthesis respond well to conservative nonsurgical treatment. Your doctor will talk to you about your options, depending on how severe your condition is.
3. Radiculopathy (Pinched Nerve)
What is Radiculopathy?
Radiculopathy is a pinched nerve in the spine. It occurs when surrounding bones, cartilage, muscle, or tendons deteriorate or are injured. The trauma causes these tissues to change position so that they exert extra pressure on the nerve roots in the spinal cord.
When the nerve roots are compressed, they become inflamed. This results in numbness, weakness, and pain. The condition can usually be reversed with timely and appropriate treatment.
Types of Radiculopathy
Types of radiculopathy are defined by the location of the compressed nerve:
What Causes Radiculopathy?
Radiculopathy occurs when a nerve is compressed by surrounding tissue. It is sometimes caused by a herniated spinal disc. This occurs when the outer rim of the disc weakens or tears. The nucleus then pushes outward and exerts pressure on a nearby spinal nerve.
Bone spurs can also cause radiculopathy. This is when extra bone forms around a disc after it weakens or collapses. These spurs can stiffen the spine and narrow the space where nerves are located, causing them to be compressed.
Pressure from a herniated disc, surrounding tissue, muscle, or tendons can cause inflammation. This interferes with nerve function. This compression can occur spontaneously. It can also result from trauma or other conditions that affect the spine. These include injury, osteoarthritis, and obesity. Age is another factor. Poor posture or stress from repetitive activities can also cause compression.
Who Is at Risk for Radiculopathy?
Many changes in your disc and vertebrae occur as you age. Radiculopathy usually affects people between the ages of 30 and 50 (Cleveland Clinic, 2009).
Conditions like rheumatoid arthritis, diabetes, and obesity can increase the risk of radiculopathy. Bone spurs can sometimes occur because of trauma or osteoarthritis. The condition can also be caused by repetitive hand, wrist, and shoulder movements. Pregnant women are also at a higher risk. It can be hereditary.
What are the Symptoms of Radiculopathy?
Symptoms of radiculopathy can range from mild to severe. The type and location of pain depends on the location of the pinched nerve root. Cervical radiculopathy usually affects the lower arm more than the neck area. Lumbar radiculopathy causes more discomfort in the lower leg than in the back area.
Symptoms of radiculopathy can include:
How Is Radiculopathy Diagnosed?
Several tests can be used to identify and diagnose radiculopathy’s cause. After an initial physical examination, X-rays can show bone alignment or narrowing of the discs. Magnetic resonance imaging (MRI) examines soft tissue, the spinal cord, and nerve roots. A computed tomography (CT) scan looks at the fine details of the bones, including bone spurs.
An electromyogram (EMG) can measure the electrical impulses of the muscles when at rest and during contractions. This helps to find evidence of damage. A nerve conduction study (NCS) measures the ability of nerves to send electrical signals.
How Is Radiculopathy Treated?
Typically, the first step in treating radiculopathy is conservative medical management.
Medications
Some medications can be effective in treating the pain and inflammation of radiculopathy:
Surgeries
Physicians sometimes recommend surgery when radiculopathy doesn’t improve within a specified period of time. This is typically after about six to 12 weeks of conservative treatment. Surgery also may be considered in cases where multiple nerves are affected or where nerve function is diminishing despite treatment.
Surgery can be used to free the affected nerve from pressure. This may require a discectomy. This procedure involves removing bone spurs or part of a herniated disc. During this procedure, a section of the vertebrae may need to be removed or fused together.
Home Care
Activities that aggravate the pain should usually be limited. Physicians can prescribe a splint, brace, or soft collar to immobilize the affected area. This helps to facilitate rest. In extreme cases, bed rest or traction may be necessary.
Physical therapy can teach patients how to strengthen, stretch, and protect the affected area.
For some patients, weight loss may help reduce pressure on the affected area.
What Is the Outlook for Radiculopathy?
Most cases of radiculopathy improve with a few days or weeks of treatment and rest. Radiculopathy caused by a herniated disc usually improves without surgery. However, recurrence of radiculopathy is possible. It can happen whether or not surgery was used for treatment.
Preventing Radiculopathy
While some causes of radiculopathy are not avoidable, there are some ways to reduce the risk. Maintaining good posture and a healthy weight reduce chances of developing radiculopathy. To prevent complications, use safe techniques when lifting heavy objects. When doing repetitive tasks, take frequent breaks.
Staying physically active can also help. Develop a regular exercise program that incorporates strength and flexibility exercises.
