Lumbar Herniated Disc/ Sciatica/ Stenosis/Spondylolisthesis
Pain along the large sciatic nerve that runs from the lower back down through the buttocks and along the back of each leg is a relatively common form of back pain. Sciatica is usually caused by pressure on the sciatic nerve from a herniated disc (also referred to as a bulging disc, ruptured disc or pinched nerve).
The problem is often diagnosed as a “radiculopathy,” meaning that a disc has protruded from its normal position in the vertebral column and is putting pressure on the radicular nerve (nerve root).
For some people, the pain from sciatica can be severe and debilitating. For others, the pain might be infrequent and irritating, but has the potential to get worse. Usually, sciatica only affects one side, and the pain often radiates through the buttock and/or leg. One or more of the following sensations may occur:
- Pain in the buttocks and/or leg that is worse when sitting
- Burning or tingling down the leg
- Weakness, numbness or difficulty moving the leg or foot
- A constant pain on one side of the buttocks
- A shooting pain that makes it difficult to stand up
Symptoms that may constitute a medical emergency include progressive weakness in the legs or bladder/bowel incontinence. Patients with these symptoms may have cauda equina syndrome and should seek immediate medical attention.
Any condition that causes irritation or impingement on the sciatic nerve can cause the pain associated with sciatica. The most common cause is lumbar herniated disc. Other common causes include lumbar spinal stenosis, degenerative disc disease, or isthmic spondylolisthesis. Nerve pain is caused by a combination of pressure and inflammation on the nerve root, and treatment is centered on relieving both of these conditions.
Conservative treatment is designed to decrease pain and inflammation, decrease intra-discal pressure, improve flexibility and mobility, and to improve muscular function and spinal stability.