Sciatica, A Symptom and its Surgery - Florida Orthopaedic Institute

Dr. Armaghani: Sciatica is an incredibly common symptom that patients come to my clinic with. I see over 2,000 patients a year and sometimes upwards of 75 percent of the patients that I see come with the main complain of leg pain, or sciatica. Sciatica is a broad symptom that can mean any number of things to different patients. In a nutshell, it basically means discomfort that goes down the leg. It can be felt as pain. It can be felt as sharp, burning, stabbing pain, spasms, or even numbness and tingling that goes down the leg which can cause weakness. All of this can be encompassed in the term “sciatica,” which in itself is not a diagnosis per say but a symptom of what’s going on. Sciatica in itself is self limited. Meaning, the vast majority of patients who have pain that goes down the leg, they get better on their own. (01:00) This can be anywhere from 75 to 90 percent. In the diagnosis to find out what is causing this symptom of sciatica, the first and always mainstay is an X-ray of the lumbar spine. Through that, we’ll be able to look at the bones and see if there’s inappropriate movement of the bones or that the bones are not lined up correctly. Eventually, they may require what’s called MRI. An MRI is good for looking at the soft tissues of the spine involving the discs and other soft tissues like ligaments. We’re able to look at this with conjunction with the X-rays to see what could be causing the sciatica. Whether it’s a disc herniation, spinal stenosis, or spondylolisthesis, movements of the bones that is inappropriate. In those patients who have pain early on, before six weeks, we typically like to send our patients to physical therapy to work on core (02:00) strengthening and stretching exercises which can help them with their pain. Some patients however, have persistent systems that extend beyond the six or 12 week mark. For those patients, we look to try to alleviate some of the pain that they’re experiencing from inflammation around their nerve. Inflammation around the nerve is what causes the discomfort that they feel down their leg. We can do this in any number of ways but one of the main ways that we do this is with an epidural steroid injection. If however, the pain comes back down their leg and they’re not doing well after therapy or epidural steroid injections, those 15 to 20 percent of patients may do well with an operation. The operation would depend on the diagnosis that they had and that would involve a conversation with their physician about what their goals of care are. (03:00)
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