FAQ’s on Sciatica/Radiculopathy
What is it?
Often referred to as lumbar radiculopathy, sciatica is a group of symptoms that involves sciatic nerve root compression, usually caused by a herniated or bulging disc in the lower lumbar back region. Radiculopathy can be a confusing term, but generally refers to pain, weakness and/or numbness that is directly related to a pinched nerve.
The term sciatica refers exclusively to the lumbar spine, whereas when it comes to radiculopathy, pain and symptoms resulting from the pinched nerve do not have to be exclusively in the lumbar spine, but can also occur in the cervical spine (the neck), resulting in tingling and numbness into the arm and hand.
What Causes the Condition?
The primary cause for radiculopathy and sciatica is nerve inflammation occurring as a direct result of a pinched nerve. This may occur somewhere along the spine, whether cervical or lumbar. For example, a patient may have a disc herniation at the C7 nerve root that causes significant pain and numbness in one of the upper extremities. The pain may travel down the arm and into the hand.
Disc herniation or bulge (protruding disc) may be the cause of radiculopathy in patients who experience these types of symptoms. The symptoms vary from patient to patient so it is important for the doctor to identify the cause for the pain or other symptoms.
What are the Symptoms of Sciatica/Radiculopathy?
The symptoms of radiculopathy vary from person to person, where one patient may experience a burning and stabbing pain due to the sensation of the nerve root and another experiences numbness or tingling sensations. Some patients may report a series of both types of symptoms occurring at different times.
Some patients report extremity sensations that feels prickly in nature, likes pins and needles. The sensation may occur in the arms, hands, feet or legs depending on the site of herniation, protrusion and nerve root compression. Muscle weakness is a less common symptom that may result in motor skill weakness, which depends on which area the nerve root innervates. When there is a cervical nerve root problem, weakness in the wrist, hand and fingers may result. A lumbar nerve compression may result in a “foot drop”.
How is the Condition Diagnosed?
Your pain management doctor, in order to address the symptoms and investigate the cause for the condition, must collect a comprehensive medical history. Typically this will raise significant suspicion for a compressed nerve.
A complete physical examination is needed to help identify where the pain originates. Positioning tests may be required where the patient lays on the table and the physician lifts the leg or raises the arm while sitting or standing, depending on the location of symptoms. This is called a Straight Leg Raise Test, which places tension on the sciatic nerve and increases pain. Bending the knee then relieves the pain nicely.
Pain or numbness in the arms may indicate a problem with the cervical spine, while pain and numbness in the leg may reveal a problem in the lumbar spine.
An MRI is usually needed for further study, which can identify disc herniations, protrusions and compressed nerves. A nerve conduction study may also be required, especially if there is weakness in the extremity. An EMG may reveal just how damaged the nerve is.
What are the Treatments?
Non-operative treatment for radiculopathy is usually effective in reducing pain and symptoms associated with the condition. A combination treatment plan that consists of medications (anti-inflammatories) and muscle relaxers, along with physical therapy, and other forms of treatment may be needed. Short-term narcotic medication may be required to help relieve immediate pain and muscle spasms associated with the condition. A pain management specialist can oversee the short-term use of these drugs.
A Medrol Dose Pak consists of a large dose of prednisone that tapers off over a few days. It should only be prescribed sparingly, as there are some side effects that can occur.
Physical therapy and chiropractic care is also effective. The treatments can relieve the burning pain, at least temporarily. They don’t solve the problem, but may alleviate symptoms.
Spinal decompression therapy has become a highly respected and effective form of treatment for radiculopathy and associated painful symptoms. Studies have shown an 85% effective rate for symptom relief. The treatment doesn’t “suck back in” the herniated disc, but it can relieve the pressure.
Along with physical therapy treatment, TENS units, ultrasound and electrical stimulation may be helpful in reducing pain.
Another highly effective treatment for radiculopathy is epidural steroidal injections that consist of cortisone medication injected around the nerve root to relieve pain. The medication reduces inflammation and is effective for reducing pain. While these types of injections do not heal a disc herniation, they are helpful in treating symptoms. Options for the injections include three different varieties:
- Intralaminar Epidurals
- Transforaminal Epidural Steroid Injections (TESI)
- Caudal Epidurals – great for treating multiple nerve roots at one time.
Conservative treatment may last for six to eight weeks and most patients are provided with pain relief and symptom reduction during this time. When spinal stenosis impacts the condition and multiple nerve roots are affected, further treatment may be required. Multiple injections may be needed to effectively reduce the pain (Elegrist et al., Pain, 2007). The overall goal of treatment, however, is to provide pain relief for the patient.
What are the Outcomes?
Over 95% of people experience pain relief without surgical procedures for radiculopathy. Burning pain, sciatica and numbness can be resolved with some form of pain relief treatment. The goal of treatment is to reduce pain and provide a patient with the best outcome possible for their condition.
Surgery is considered in the following 3 situations:
- Failure of pain relief with treatment over 6 to 8 weeks.
- Progressive neurologic deficit, such as a foot drop that is getting worse.
- Bowel and Bladder Symptoms – this is a surgical emergency.
If you or a loved one experience any of the symptoms associated with radiculopathy and sciatica, treatment with a pain management specialist can help considerably. The outcomes from surgery have been shown to be equivalent to conservative management at the one year point in a landmark study published in the Journal of the American Medical Association.
While surgery can alleviate pain faster, there are some small but real risks associated with it. All efforts should be tried to avoid the procedure, which is typically possible 95% of the time.