Sciatica - Sciatic Pain

Among the most commonly reported symptoms, sciatica impacts millions.

Sciatica - Back & Leg Pain

Overview of Sciatic Nerve Pain

Sciatica, also known as sciatic nerve pain, is a very common back pain symptom that impacts millions of Americans every year. Sciatic nerve pain is described as pain that radiates from the low back down through the hip and leg. Often, this radiating leg pain will involve the foot as well. It is important to think of ‘sciatica’ as a symptom and not as a diagnosis in and of itself. Being ‘diagnosed‘ with sciatica is not specific enough to enable the development of an effective and focused treatment course. For this reason, it is highly recommended that patients with radiating leg pain be evaluated by a physician specialist with a background in spine conditions. At Elite Pain & Health, our Oklahoma Pain Management Doctors have extensive experience in the evaluation, diagnosis, and treatment of the wide range of conditions that lead to sciatica and sciatic nerve pain.

Sciatica Sources: INSIDE vs. OUTSIDE the Spine

Sciatica can occur from problems inside the spine itself or conditions outside of the spine. Most commonly, patients will be assumed to have a problem within the vertebral discs of the spine, such as with herniated or protruding discs. However, it is essential to consider other causes of sciatica or radiating leg pain. Although less common, there are several causes of sciatica involving areas beyond the spine.

Spine Disorders That May Lead To Sciatica Symptoms

Degenerative Disc Disease

Herniated Disc (bulging, protrusion, extrusion)

Lumbar Radiculopathy

Spinal Stenosis

Lumbar Spondylosis

Facet Joint Syndrome

Post-Laminectomy Syndrome (failed back)

Ankylosing Spondylitis

Tethered Cord Syndrome

Spine Tumors & Spinal Cysts

Viral Infections (example: shingles)

Epidural Abscess or Hematoma

Degenerative Disc Disease

Common Spinal Cause of Sciatica

Many people get concerned when being diagnosed with a ‘degenerative‘ condition. However, this is a natural and painless part of aging that impacts many structures of the body, including joints and bones. A disc, described above, becomes degenerated over time as the tissue loses its moisture content, shrinks, thins, and hardens. Sometimes this process is sped up by repeated injury or even trauma, and your body may produce less functional scar tissue. Many people are found to have ‘degenerated discs’ when X-rays, CT Scans, or MRI is performed in cases where they don’t have pain. Stated another way, most people beyond a certain age have ‘degenerative disc disease’ that does not cause pain and maybe a natural part of aging. However, vertebral discs can be the source of significant pain in certain circumstances.

Vertebral discs have nerves contained within them that are capable of transmitting pain signals to the brain. When pain originates from a vertebral disc, it called ‘discogenic’ pain. Discogenic pain is thought to occur within discs that have suffered an injury or following degeneration leading to the weakening of the fibrous tissue of the disc. A tear within the disc is an ‘annular tear’ or ‘annulus tear’ on an MRI report.

Vertebral discs can also result in a mechanical pain that results from the disc pushing on or leaning on nerves that travel nearby within closed tunnels or canals. Two of the most common sources of sciatic pain are neuroforaminal stenosis and spinal (canal) stenosis.

Neuroforaminal stenosis can occur when a bulging or prolapsed portion of a disc compresses a spinal nerve root as it travels through an opening on the left or right side of the spine. This opening in the spine is called a neuroforamen, and stenosis means an abnormal narrowing of the neuroforamen or opening of the spine. Neuroforaminal stenosis is among the most common cause of sciatica and lumbar radiculopathy.

Spinal Canal Stenosis occurs when the canal that travels from the brain down through the spine gets narrowed or closed off because of disc material bulging out into the canal. Vertebral disc bulging, prolapse, extrusion, or herniation are terms used in MRI reports indicating the level of the disc penetration into the canal. Disc bulges are the most common and can be present in patients that do not have symptoms of sciatic pain.

Degenerative Disc Disease - Sciatica Causes

Herniated Discs

Bulging - Protrusion - Prolapse - Extrusion

As discussed previously, herniated discs are a major cause of both neuroforaminal stenosis and spinal canal stenosis. However, the presence of a herniated disc does not necessarily result in significant pain symptoms. It is for this reason that we recommend that all patients with significant sciatic pain should be evaluated by a pain specialist experienced in evaluating, diagnosing, and treating patients with these conditions. All too often, patients are referred for surgical treatment by a primary care provider that may not realize the pain may be from another source. Our Oklahoma pain management specialists will help you identify the source of your sciatica and provide surgery-free treatment options in an effort to get you the relief you are seeking. Click on the video here to learn more about herniated discs.

Lumbar Radiculopathy

Low Back Pain Radiating to Legs

Sciatica and lumbar radiculopathy are often used interchangeably to describe a pattern of symptoms that includes back pain with associated hip, thigh, or leg pain. Lumbar radiculopathy or sciatic pain may also involve the lower leg down to the feet and toes depending on which nerve root is being ‘pinched’. The report of a pinched nerve is often used to describe the condition of lumbar radiculopathy. Again, it is important to have an Oklahoma pain treatment specialist to evaluate your condition in order to provide you with the best treatment options. The overwhelming majority of patients do not require surgery for this condition.

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Sciatic Nerve Pain - Lumbar Radiculopathy OKC

Spinal Stenosis

Spinal stenosis or spinal canal stenosis if a common cause of spine-related pain disorders. As above, it is noted to occur often in response to herniated discs or disc bulging that is significant. These defective vertebral discs push into the space of the spinal canal and can ultimately begin to place pressure on the spinal cord or pinch spinal nerve roots. On an MRI scan report, the spinal canal stenosis is often graded as mild, moderate, or severe. Interestingly, the grade of spinal stenosis doesn’t always correlate with the severity of sciatic nerve pain. This is why it is important to explore all your treatment options, including surgery-free treatments before you move forward with a surgical procedure for your spine.

Spondylosis & Facet Disease in Sciatic Nerve Pain

Lumbar Spondylosis

Lumbar spondylosis is a generalized degenerative process that can impact the entire spine but most commonly the lumbar spine. This condition is related to simultaneous degeneration of discs, the formation of bone spurs, as well as deterioration of the joints on the back of the spine called facet joints. Sciatica symptoms many times caused by this form of degenerative spine disease, and it is more common with advancing age.

Facet Joint Syndrome

Facet joints are the small joints on the back of the spine that support you when we bend backward, rotate, or extend your spine. Among the most common spinal conditions, facet joint syndrome is equivalent to joint osteoarthritis in the spine. It is rarely a cause of needing surgery, and an Oklahoma pain management specialist is often the best source of obtaining an evaluation, diagnosis, and treatment for this condition.

Post-Laminectomy Syndrome

Failed Back Surgery Syndrome

Post laminectomy syndrome or failed back surgery syndrome occurs in many patients that have had spinal surgery. In this syndrome, scar tissue can build up around the spine surgery site and result in severe and debilitating chronic sciatic pain. Often, spine surgeons will refer patients experiencing this condition to an interventional spine pain specialist for evaluation and treatment. There are a number of therapies that have helped patients with the difficult post-surgical syndrome such as spinal cord stimulation therapy or lumbar epidural adhesiolysis (aka Racz Procedure). Our Elite Pain & Health Oklahoma pain treatment centers have extensive experience in the treatment of patients with this condition.

Ankylosing Spondylitis

Sciatica pain may be a sign of systemic disease such as ankylosing spondylitis which is related to other autoimmune inflammatory arthritic diseases like rheumatoid arthritis. In ankylosing spondylitis, your immune system attacks the spine joints causing potentially disabling inflammation and pain. This condition can lead to the fusing of the joints of the spine which can severely limit the range of motion and contribute to pain and disability.

Tethered Cord Syndrome

Tethered cord syndrome can present with sciatic pain symptoms also. In this condition, the tethered cord often occurs during a developmental problem within the spine and may be associated with another condition known as spina bifida. Although it is a rare developmental disease that one is born with, symptoms may not present until adulthood. Fortunately, tethered cord syndrome is not a common condition but should be considered in those with a history of new-onset sciatica and spinal deformities such as spina bifida.

Less Common Sciatica Back Pain Causes

Spine Tumors & Cysts

Although relatively rare, tumors or benign cysts or growths within the spine may present first as sciatic pain. Pain at rest or that is worse at night should prompt further assessment to rule out these conditions as a potential cause of sciatica. In particular, patients with a history of cancer should consider this as a possible source of their symptoms. Imaging studies of the spine are often the method of choice for identifying this diagnosis.

Viral Infections (example: shingles)

Viral infections such as shingles have been known to mimic spine pain conditions and result in sciatica pain symptoms. If the pain precedes the onset of a severe, painful rash over one area of the lower back or down the leg on one side, it could be related to shingles. Cases of sciatica symptoms resulting from shingles usually become more clear over the week or so after the onset of symptoms because of the associated painful rash.

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Epidural Abscess or Hematoma

A rare but potentially dangerous cause of sciatic pain symptoms is an epidural abscess or hematoma. Patients with active infections that have had surgery or procedures on the spine should consider epidural abscess as a possibility. Also, patients taking blood thinners or anti-coagulants should consider epidural hematomas as a possibility, especially with recent spinal instrumentation or procedures. Whether caused by pressure from a growing hematoma, spinal hemorrhage, or abscess formation in or near the epidural space, the result can be rapid and significant levels of pain and disability that can progress over mere hours. Either of these conditions are considered emergent and may require an urgent surgical procedure to treat, unlike most of the conditions that lead to sciatica pain.

Sciatica Causes From Outside The Spine

1

Sacroiliac Joint Disease (sacroiliitis)

2

Hip Arthritis

3

Piriformis Syndrome

4

Sciatic Nerve Neuritis

5

Tumors & Cysts Outside the Spine

6

Pelvic Disease (example: endometriosis)

Sacroiliitis

Sacroiliac Joint Pain

An extremely common condition, sacroiliac joint pain is commonly confused with classic sciatica pain symptoms. It is also possible for sacroiliitis to develop in patients suffering from sciatic pain symptoms. This overlap can present challenges for proper diagnosis and treatment and is another reason that patients benefit from evaluation by a pain specialist. A physician experienced in the treatment of both sciatic nerve pain as well as sacroiliac joint disease is able to identify the primary pain source. Watch the sacroiliac joint pain video linked here to learn more.

Hip Arthritis

Hip arthritis is among the most common forms of arthritis experienced by people as we age. The most common form is osteoarthritis which is a degenerative, wear and tear condition impacting many hips. Patients are sometimes referred to spine surgeons for ‘sciatica’ symptoms only to find out later that they have hip arthritis. Working with an Oklahoma pain management doctor enables you to have the benefit of a physician capable of identifying and treating both spine and hip problems.

Piriformis Syndrome

Learn more about Piriformis Syndrome here!

Other Conditions Mimicking Sciatica

Sciatic Nerve Neuritis

The sciatic nerve may become inflamed due to infection, autoimmune disease, or direct trauma. The term ‘sciatic neuritis’ has been used interchangeably with sciatica on occasion, particularly in much older descriptions of back and leg pain. It is not a commonly used term today unless specifically referring to an inflamed sciatic nerve which is much rarer than classic sciatica symptoms.

Tumors & Cysts Outside the Spine

A tumor, growth, or cyst applying pressure to a sensitive nerve structure such as the sciatic nerve may cause sciatica pain symptoms.

Pelvic Disease

Endometriosis and other pelvic conditions can cause referral pain that may be confused for spine-related related pain conditions such as sciatica.

CONCLUSION

Get Your Sciatica and Sciatic Nerve Pain Evaluated!

In summary, sciatica pain symptoms can result from many different sources both inside and outside the spine as discussed above. A proper low back specialist evaluation is important to both evaluate and treat the causes of your pain. At Elite Pain & Health, our Oklahoma Pain Management Specialists treat thousands of Oklahomans with sciatic pain symptoms. We are committed to providing Oklahoma the most comprehensive and advanced surgery-free options available. We look forward to getting you back to the active life you deserve. Call and schedule your appointment today!

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