Sciatica
Medical Author: William C. Shiel Jr., MD, FACP, FACR
Medical Editors: Kenneth Kaye, MD, and Melissa Conrad Stöppler, MD
Epidural Cortisone Injections for Sciatica From
Herniated Disc...Beneficial?
Medical Author: Medical Author: William C. Shiel Jr., MD, FACP, FACR
The discs of the spine are located
between the vertebrae (bony building blocks of the spine).
The disc is designed somewhat like a jelly donut being composed
of an inner gelatin-like core (the nucleus pulposus) surrounded
by a firm outer ring (the annulus fibrosus).
When the disc structure wears, because of processes
such as aging or trauma, it becomes weakened and susceptible to
injury. In this condition, stresses on the spine can cause the
inner core to protrude outward through the boundary of the disc's
outer ring. The is referred to as herniation of the disc.
Disc herniation can directly press upon the spinal
cord and/or adjacent nerve tissues resulting in pain which radiates
outward from the spine in the distribution of the affected nerve.
When the disc herniation is in the spine of the lower back, it
can cause a radiating pain down the legs, commonly referred to
as sciatica.
A majority of patients with sciatica from disc herniation
have resolution of their pain with various conservative measures,
including antiinflammatory and muscle-relaxant medications, exercises,
physical therapy, and time. However, some 10%-15% of affected
patients require surgical procedures to relieve the pain.
What is sciatica?
Sciatica is pain resulting from irritation of the sciatic nerve.
The pain of sciatica is typically felt from the low back to behind the thigh and radiating down below the knee. The sciatic nerve is the largest nerve in the body and begins from nerve roots in the lumbar spinal cord in the low back and extends through the buttock area to send nerve endings down the lower limb.
What are causes of sciatica?
While sciatica is most commonly a result of a disc herniation directly pressing on the
nerve, any cause of irritation or inflammation of this
nerve can reproduce the symptoms of sciatica. These causes include irritation of
the nerve from adjacent bone, tumors, muscle, internal bleeding, infections, injury, and other causes.
What are symptoms of sciatica?
Sciatica causes pain, a burning sensation, numbness, or tingling radiating from the lower back and upper buttock down the back of the thigh to the back of the leg. Severe sciatica can make walking difficult if not impossible. Sometimes the symptoms of sciatica are aggravated by walking or bending at the waist and relieved by lying down.
How is sciatica diagnosed?
Sciatica is diagnosed with a physical exam and medical history. The typical symptoms and certain examination maneuvers help the health-care practitioner to diagnose sciatica. Sometimes,
X-rays, films, and other tests, such as CT scan, MRI scan, and electromyogram, are used to further define
the exact causes of sciatica.
Next: How is sciatica treated? »
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