Sciatica & Radiculopathy
What are Sciatica and Radiculopathy?
Radiculopathy is pain from any spinal nerve. It is often called "referred pain," and may affect the entire course of the nerve's path.
"Sciatica" is a commonly used word to describe leg pain from problems in the spine. The sciatic nerve arises from the spinal nerves L4, L5, S1, S2, and S3. Those nerves don't become the sciatic nerve until they leave the pelvis and run into the leg. However, the term "sciatica" is generally understood as any nerve pain going into the legs. Problems with the sciatic nerve are uncommon and much more rare when compared to radiculopathy and problems of the spinal nerves.
Causes
Radiculopathy can arise from a damaged or irritated nerve. Damage or irritation may be caused by trauma or other degenerative conditions ("wear and tear") of the spine.
Radiculopathy is pain in the leg(s) from the spinal nerves.
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Bone spurs: As vertebra become worn out or arthritic, bone spurs which may press on spinal nerves as they exit the spinal column.
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Degenerative disc disease: All joints in the body become enlarged if they are arthritic (for example, someone with hand arthritis will have enlarged knuckles). As intervertebral discs and facet joints become arthritic and enlarge, they will often press on exiting nerve roots and cause radiculopathy.
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Herniated discs: When damage occurs to the disc wall, a piece of the inner disc may "herniate" and press on a spinal root.
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Spine instability: In severe cases, the spinal vertebra may be so worn out that they shift forward and backward. When this happens, the "foraminae," or tunnels for nerves to exit the spine, may close and pinch the nerves that pass through them.
Symptoms
People with radiculopathy often report an "electrical" or "shooting" pain that radiates outward from the spine down one of the arms or legs. It is important to try and locate the exact locations of the pain to report to your doctor. This will help him or her to determine which spinal nerve(s) are affected. Patients with more advanced nerve damage may have weakness in the arms or legs.
Diagnosis
The most important part of the diagnosis is a proper evaluation by a specialist.
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History: Your medical provider should appreciate that your medical history may contribute to your symptoms, which may or may not be related to your symptoms. It is also important to understand the timeframe for your symptoms, and what makes the symptoms worse or better. Your provider will also learn all previous treatments you have had, and if they have provided any relief.
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Physical Examination: In addition to a good medical history, a thorough physical examination is the most important part of the diagnosis for any spine-related problem. During the physical examination, your provider may try to reproduce your symptoms, and will assess any long-term nerve damage that may have been caused.
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X-rays: X-rays are often the first step for imaging. Even if other images have been taken, x-rays provide unique information that is not available from other studies. X-rays may show spinal instability that is not visible on other imaging studies.
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MRI: An MRI scanner uses a magnetic field and radio waves that are not harmful to visualize the body in 3D. In most circumstances, it is the best way to see the soft tissues of the body, including nerves, intervertebral discs, and other parts of the spine other than the bones. An MRI or a CT scan is necessary to diagnose lumbar spinal stenosis.
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CT: A CT scan uses many x-rays to produce a 3D image of the body. It is often the best way to visualize the spinal bones or bone spurs.
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Injections: Spinal injections may be used to help diagnose the cause of a patient's symptoms. In addition to providing relief, they also provide useful information for your provider to pinpoint the cause of symptoms. If you have an injection, it is important to document how the injection affected your symptoms.
Treatment
Radiculopathy may cause severe pain that significantly reduces quality of life for some people. Treatment options vary based on the severity of symptoms and the degree of damage to the affected spinal nerves.
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Medications: Some medications, such as gabapentin (Neurontin®) or pregabalin (Lyirca®) may treat the pain caused by radiculopathy. It is important to increase and decrease the dosage of these medications slowly and under the guidance of a physician, because they may cause seizures if not taken properly.
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Injections: Spinal injections may be used to treat radiculopathy. Using a combination of local anesthetic, this may help to decrease the inflammation in the affected nerve root. Spinal injections may provide temporary or lasting relief, depending on the technique and underlying reason for radiculopathy.
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Surgery: For those patients who do not improve with spinal injections and nonsurgical methods, an operation may be recommended. Since there are many potential causes of radiculopathy, there are several ways to treat it with an operation. It is important to have a discussion with your surgeon about how best to treat it. Often, a minimally invasive procedure can relieve symptoms with a short recovery and only a few restrictions. Some surgical options include Lumbar Microdiscectomy, Lumbar Decompression, or Lumbar Fusion.