Sciatica Symptoms, Causes, Diagnosis, and Treatment

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The Universal Guide to Sciatica: Everything you ever wanted to know, straight from the experts.

In This Article:What Is Sciatica?|什么是坐骨神经?|What Are Common Sciatica Symptoms?|What Causes Sciatica?|How Is Sciatica Diagnosed?|What Are Some Nonsurgical Sciatica Treatments?|Do You Need Sciatica Surgery?|What Type of Sciatica Surgery Do You Need ?|Sources

The sharp, shooting nerve pain of sciatica can take your breath away. When low back pain radiates through the buttocks and down the leg, the symptoms are known as sciatica. Although sciatica is common—affecting up to 40% of adults—there are many misconceptions about what sciatica is.

Illustrationof the sciatic nerve and pain distributionLeg pain that descends below the knee is the classic hallmark of sciatica, a type of lumbar radiculopathy. Photo Source: 123RF.com.

What Is Sciatica?

Sciatica is not a disorder itself but is a general term used to describe the pain that occurs when nerve roots in the lumbosacral spine (low back) become compressed (pinched), irritated, or inflamed, often from aherniated discor other narrowing of the spinal canal (calledstenosis). Sciatica may be accompanied by numbness/tingling and muscle weakness.

“Sciatica means that there is irritation or a problem with the sciatic nerve that usually emanates from the low back, from the nerve roots in the spine,” explains orthopedic surgeonJeffrey C. Wang,医学博士, who is Chief of the Orthopaedic Spine Service and Co-Director of the University of Southern California Spine Center in Los Angeles. The nerve irritation or compression activates the sciatic nerve and causes pain and other symptoms down the leg on the path of the affected nerve, he says.

Not all radiating pain in the butt area or down the leg is sciatica. In most cases of sciatica, the pain extends down past the knee, Dr. Wang says. Also, true sciatica is caused by impingement (pinching) or inflammation of the sciatic nerve, while sciatica-like symptoms can stem from joint or muscle problems. It is important to work with your doctor to determine the cause of sciatica to find the best treatment to relieve your pain.

What Is the Sciatic Nerve?

The sciatic nerve is the longest and largest nerve in the body; its diameter is about three-quarters of an inch. It originates in the sacral plexus; a network of nerves in the lower back (lumbosacral spine). The lumbosacral spine refers to the lumbar spine (lumbo) and the sacrum (sacral)合并,在脊柱的底部和尾骨(Coccyx)上方。

Sciatic nerve illustrationThe sciatic nerve is the longest and largest nerve in the body.

The sciatic nerve exits the sacrum (pelvic area) through a nerve passageway called the sciatic foramen. At the upper part of the sciatic nerve, two branches form; the articular and muscular branches. The articular branch goes to the hip joint (articular means related to a joint). The muscular branch serves the muscles of the leg.

The sciatic nerve has several smaller nerves that branch off from the main nerve. These nerves--the peroneal and tibial nerves--enable movement and feeling (motor and sensory functions) in the thighs, knees, calves, ankles, feet, and toes.

What Are Common Sciatica Symptoms?

坐骨神经痛是腰部根部病的最常见症状,一种被描述为疼痛的疾病,以及沿神经路径发现的麻木或刺痛,肌肉无力或反射不良。

“Radiculopathy” means irritation or injury to a nerve root that causes pain and other symptoms that radiate away from the affected nerve root. In the case of sciatica, usually the pain is felt as low back pain that radiates down the leg.

Pain is the hallmarksciatica symptom。Although sciatica symptoms may be felt anywhere along the sciatic nerve, classic sciatica radiates from the low back into the butt, and down the leg to below the knee. In fact, your doctor will usually check for sciatica if you have low back pain. Less commonly, sciatica pain may be felt starting in the buttocks or hip area and radiates down the leg.

坐骨神经痛通常被描述为电动,燃烧或尖锐。神经疼痛可能从轻度到令人难以置信,当您弯曲,扭曲脊柱或咳嗽时会恶化。

Although you have two sciatic nerves (one on each side of your body), sciatica symptoms typically only occur on one side of the body. If you have radiating pain down both of your legs, it is less likely that the pain is caused by a pinched sciatic nerve, Dr. Wang says.

In addition to pain, if the sciatic nerve is compressed, the muscles it serves may become weak. It may be hard to bend your knee, bring your thighs together (adduction), and point your foot and/or toes upward or downward.

What Causes Sciatica?

In short, anything that compresses or pinches the sciatic nerve (particularly where it exits the spine) cancause sciatica,王博士说。一些最常见的包括:

  • Herniated discs:下背部的椎骨之间的橡胶盘可能会凸起或疝气,从而引起坐骨神经根的刺激和/或压缩。必威 app椎间盘突出或凸起的椎间盘是坐骨神经痛的最常见原因。
  • 退化性椎间盘疾病:With age, vertebral discs may start to wear down. If the discs become too thin, the space between each vertebra becomes compressed, putting pressure on the sciatic nerve root. If the outer covering of the discs wear down, fluid from the disc may leak out and irritate the sciatic nerve.
  • Bone spurs:An overgrowth of bone (osteophyte) on the vertebrae can put pressure on sciatic nerve roots. These bone spurs often form near vertebra affected byosteoarthritis
  • Spinal stenosis:Spinal stenosis is a narrowing of the space that the spinal cord and sciatic nerve roots travel through, causing compression. This narrowing may be caused by arthritis or aging.
  • Spondylolisthesis:椎骨被设计为将一个堆叠在另一个以稳定性。如果下背部的一个椎骨在其下方的椎骨上向前滑动(必威 app脊椎滑落术),则可以按下坐骨神经。
  • Vertebral fracture:The sciatic nerve can be compressed if the part of the vertebra that forms a joint (pars interarticularis) cracks or fractures, which is known asspondylolysis
  • Piriformis syndrome: The piriformis muscle typically runs on top of the sciatic nerve in the buttocks and can compress the sciatic nerve if the muscle becomes too tight. The symptoms may get worse after sitting for a long time, walking up stairs, walking, or running. The piriformis muscle is a flat band-like muscle that runs from your sacrum (the triangular bone below your spine) to the top of the thigh bone in the hip joint.

Other conditions can mimic the symptoms of sciatica, but are not truly caused by sciatic nerve impingement, Dr. Wang explains. For example,s骨关节功能障碍is a joint problem in the pelvis that causes pain in the buttock that may radiate down into the upper leg.

A tight iliotibial band (the tendon that runs the length of your outer thigh) or hamstring muscle can mimic the radiating symptoms of sciatica. Additionally, “stress on the spine from怀孕会导致辐射背痛, that is not typically sciatica in the classic sense,” Dr. Wang says.

Wang博士说:“如果辐射疼痛留在臀部区域,并且不会向下走向大腿或仅在大腿的一半上行驶,那么它不太可能是坐骨神经痛。”

另一个严重的状况称为cauda equina syndrome(often caused by a herniated disc pressing on the cauda equina nerve roots at the end of the spine) can be mistaken for sciatica. In addition to radiating pain and weakness, cauda equina syndrome may lead to bowel or bladder incontinence. Cauda equina syndrome is a medical emergency and can lead to permament problems. See your doctor right away if you are having symptoms.

Common Causes of SciaticaThe most common causes of Sciatica.

How Is Sciatica Diagnosed?

When searching for the cause of sciatica symptoms, spine specialists “usually start with the spine just because the most common cause of sciatica is pinching or compression of the sciatic nerve roots in the spine, most commonly from a herniated disc,” according to Dr. Wang.

Your doctor will take a medical history and ask questions such as what makes the symptoms feel better or worse and where the symptoms are felt. Then, during a physical exam, your doctor will see what movements make your symptoms worse and will test for muscle strength, decreased sensation, and reflexes.

Wang博士解释说:“如果存在赤字,并且症状与同一神经根相一致,我们开始认为原因可能是神经的神经,我们可以将原因定位在特定的神经根上。”

一项考试称为直腿升高测试,您躺在桌子上,医生慢慢抬起一条腿,看看它是否加剧了症状以及症状在什么时候开始。该测试会延伸坐骨神经,因此,如果有任何缝隙,该测试将导致坐骨神经痛。同样,如果您以某种方式弯曲并改变脊柱位置时症状增加,那表明坐骨神经痛症状可能来自您的脊椎。

Sciatica straight leg raise testThe straight leg raise test can help your doctor diagnose sciatica.

为了确认诊断,您的医生可能会订购成像研究。Wang博士解释说,X射线会发现骨质问题,MRI将指出神经压缩的位置。

What Are Some Nonsurgical Sciatica Treatments?

大多数患有坐骨神经痛症状或烟囱bar radiculopathy improve over time and respond well to non-surgical treatments, such as medication,锻炼and special sciatica stretches, andphysical therapy(pt)。脊柱操纵,例如脊椎治疗,也可以帮助减轻坐骨神经痛症状。在大多数情况下,坐骨神经痛在4到6周内变得更好。

Wang博士说:“坐骨必威betway微博神经痛的标准治疗方法包括PT,运动,避免加重症状的活动以及OTC非甾体类抗炎药(NSAID)。”“如果那不起作用,疼痛是急性的,那么下一步通常是注射硬膜外类固醇注射或神经根块。”

In some cases, a short course of oral steroids may be considered before trying steroid injections. Under a doctor or healthcare provider’s advice, over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs) may help reduce swelling and sciatic pain. There are many types of OTC medication, such as acetaminophen (eg, Tylenol), ibuprofen (eg, Advil), or naproxen (eg, Aleve).

Do You Need Sciatica Surgery?

大多数患有坐骨神经痛症状或烟囱bar radiculopathy respond well to non-surgical treatments, such as medication,锻炼and special sciatica stretches, and physical therapy.

“If your quality of life is good, and you are still able to work and do the things you want to do, there is no reason to have surgery,” Dr. Wang notes. However, if a person comes into his office and can barely sit down, can’t work, and can’t take care of their family, surgery may be the best option.

Wang博士说:“如果您尝试保守的治疗方法并且疼痛不会变得更必威betway微博好,如果您的渐进性神经系统弱点没有改善或无能为力,那么手术可能会比以后更快地考虑。”王博士说:“我总是将手术视为最后一步。”他补充说,进行手术的决定通常是自然而然的。

Sometimes, sciatica andlower back pain can be seriousand require surgery. Surgical treatment for sciatica is recommended for patients with:

  • Loss of bowel and/or bladder function (this is a symptom of the rare conditioncauda equina syndrome)
  • Severe leg weakness
  • 非手术坐骨神经痛治疗无效或不再减轻坐骨神经痛
  • Progressively worsening pain

对于合适的患者,手术可能非常有效。在一个小2020 study in新英格兰医学杂志patients with sciatica due to a herniated disc who had surgery reported much lower pain levels than the people who underwent PT only.

Medical guidelines also state that for patients with severe symptoms, discectomy for a herniated disc with radiculopathy (radiating pain) “is suggested to provide more effective symptom relief” than nonsurgical treatments such as PT and steroid injections.

“Studies have shown that surgery can be very successful for sciatica, especially when there is real nerve compression, whether it is from a herniated disc, spinal stenosis, disc degeneration, bone spurs, or spondylolisthesis,” Dr. Wang explains. “The type of surgery selected depends on the cause of sciatica.”

What Type of Sciatica Surgery Do You Need?

The type of surgery recommended depends on the diagnosis, number of spinal levels requiring treatment and surgical goals. In general, “we try to do the smallest surgery possible,” Dr. Wang says.

Most surgeries to relieve sciatica are called spinal decompression surgeries, which are procedures the spine surgeon performs to remove whatever is pressing on the sciatic nerve—such as a disc herniation. Some patients need a combination of these surgeries to relieve sciatica symptoms.

Many patients undergo decompression surgery in an outpatient or ambulatory spine center without being hospitalized. Also, many of these procedures can be performed usingminimally invasive spine surgery(小姐)。

Sciatica minimally invasive spine surgeryMinimally invasive spine surgery uses small incisions, small tools and a flexible camera. It carries less risk and may be easier to recover from than traditional open surgery.

微创方法的好处包括减少疼痛和手术后更快的恢复,部分原因是通过软组织切割较少(例如,韧带,肌肉)。这种方法还与较低的感染风险和手术失血率较小有关。

Minimally invasive surgery is a good option for patients who have a herniated disc or spinal stenosis in only one vertebrae. For patients who need surgery in multiple vertebrae or a more complex surgery, a traditional open surgery may be best.

微片切除术

“If sciatica is caused by a herniated disc in the lumbar spine, which is one of the most common reasons for sciatica, then a simple minimally invasivemicrodiscectomy被使用了,”王博士说。“微歧视的结果通常非常好。”

微片切除术involves a small incision, is a short surgery, and is typically performed in the outpatient setting, Dr. Wang notes. During either procedure, the surgeon removes the entire disc or the portion of the disc compressing nerve(s). In some cases, an artificial disc replacement is placed to help restore space and movement between the vertebrae.

Laminotomy and Laminectomy

Laminotomy and laminectomy通常用于治疗脊髓狭窄和发票吗olve removing a part of the spine called thelamina—a thin bony plate that protects the spinal canal. The lamina is located at the back or posterior spine between two vertebrae. The difference between these procedures is the amount of lamina removed to access bone, disc, or other soft tissue compressing spinal nerve roots.

  • Laminotomy involvespartialremovalof the lamina.
  • 椎板切除术涉及total removalof the lamina.

By partially or entirely removing a lamina, the surgeon can access the bulging or herniated disc from the posterior spine. Of course, the surgeon may remove other tissue (eg, bone spur) pressing on a spinal nerve root at a particular spinal level (eg, L4-L5).

有孔切开术

有孔切开术enlarges the hole (called a foramen) where the spinal nerve root exits the spinal canal. A small incision is used to remove small pieces of bone that are pinching the sciatic nerve root.

Interspinous Spacers

Small devices calledinterspinous spacers有时用于脊髓狭窄的人吗to help keep the spinal canal open, so the nerves are no longer pinched.

Spinal Fusion

In patients with spinal instability from spondylolisthesis or degenerative disc disease at different levels of the spine,spinal fusionof the vertebrae may be required, Dr. Wang says. This is a more extensive surgery designed to strengthen the spine and prevent painful movements. In spinal fusion, the spinal discs in two or more vertebrae are removed and the vertebrae are fused (joined together) by bone grafts and/or metal devices that are screwed into place.

The good news is that sciatica goes away over time in many people with conservative therapies, and that surgical options also have a high success rate, Dr. Wang says. The most important step is to see your doctor to make sure there are no urgent problems and to find the underlying cause of sciatica.

It's time to get rid of your sciatica once and for all. Step one is finding out the specific cause of your sciatica, so you can get the most effective treatment for your particular condition. Dig deeper intosix common sciatica causes。而且,当您准备好进行牢固诊断或需要治疗时,find a spine specialist near you谁可以提供帮助。

继续阅读:Sciatica Symptoms and Causes

Sources

American Academy of Family Physicians. (2018.) “Piriformis syndrome.”familydoctor.org/condition/piriformis-syndrome/

American Academy of Orthopaedic Surgeons. (2016.) “Spondylolysis and spondylolisthesis.”orthoinfo.aaos.org/en/diseases--conditions/spondylolysis-and-spondylolisthesis/

美国神经外科医生协会。(n.d.) “Cauda equina syndrome.”www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Cauda-Equina-Syndrome

美国神经外科医生协会。(N.D.)微创脊柱手术。www.aans.org/patients/neurosurgical-conditions-and-t必威betway微博reatments/minimally-Invasive-Spine-Sergery

肉质。(2019) “A review of lumbar radiculopathy, diagnosis, and treatment.”www.ncbi.nlm.nih.gov/pmc/articles/PMC6858271/

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2020.) “Spinal stenosis.”www.niams.nih.gov/health-topics/spinal-stenosis

National Institutes of Health. (2019.) “Sciatica.”medlineplus.gov/sciatica.html

National Institute of Neurological Disorders and Stroke. (2020.) “Low Back Pain Fact Sheet.”www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

North American Spine Society. (2012.) “Clinical Guidelines for Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy.”www.spine.org/portals/0/assets/downloads/researchclinicalcare/guidelines/lumbardischerniation.pdf

Statpearls [Internet]。(2020)“解剖学,坐骨神经”。www.ncbi.nlm.nih.gov/books/NBK482431/

Statpearls [Internet]。(2020) “Sciatica.”www.ncbi.nlm.nih.gov/books/NBK507908/

更新:05/12/21
Jeffrey C. Wang,医学博士
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Leading Causes of Sciatica and Sciatic Nerve Pain

Sciatica, also called lumbar radiculopathy, is mild to intense pain that radiates from the low back into the left or right leg. Sciatic nerve pain symptoms include numbness, tingling sensations, and weakness.
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