How to deal with sciatica
What is sciatica?
Sciatica is pain that radiates along the distribution of the sciatic nerve. It is typically accompanied by low back pain, which could be anything from mild to severe and debilitating.
What causes sciatica?
The spine has three major sections: the cervical, thoracic and lumbar spine.
The spinal canal has a small opening at the end of each segment to allow spinal nerve roots to exit and combine, forming proper nerves. In the lumbar region, the L4, L5, S1, S2 and S3 nerve roots combine to form the sciatic nerve. The sciatic nerve is the largest branch of the lumbosacral plexus.
The sciatic nerve then exits into the pelvis and on to supply the muscles of the legs. The sciatic nerve is in fact the longest nerve in the body.
Sciatica happens when this nerve (or more commonly the nerve roots), get pinched (compressed) or irritated.
Some of the reasons that cause sciatica include:
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Herniated lumbar disc / disc prolapse / slipped disc / disc bulge
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Lumbar degenerative disc disease or degeneration of other discs
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Spondylolisthesis
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Muscle spasm or inflammation of the pelvic muscles
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Inflammation of lumbar discs or bone spurs
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Sacroiliac joint dysfunction
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Piriformis Syndrome
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Spinal trauma or injury to the spine
What does sciatica feel like?
Sciatica is typically a very painful condition, with pain radiating from the back, down below the knee and into the foot. The pain is described differently by different patients, with some describing it as sharp, pulling, burning, or perhaps a dull ache. Some patients describe the pain as a severe tooth-ache.
Along with pain, other sensations you may feel include numbness and pins and needles. Occasionally you may experience weakness in association with your sciatica. If this is the case an urgent assessment is usually recommended.
Pain may worsen with prolonged sitting, standing, twisting, lifting, straining, or coughing and sneezing. Sciatica pain can be confused with other lower back pain. Sometimes delay in treatment also leads to other medical problems due to Sciatica.
Typically, Sciatica affects one limb, but it can affect both at the same
Risk factors for sciatica
Genetics, lifestyle, and your spine’s anatomy can increase the risk of having Sciatica. Some risk factors that may trigger Sciatica include:
- Age: Progressing age makes the spine prone to degeneration or change in its anatomy, making you susceptible to having various spinal disorders, including Sciatica.
- Obesity: Excess fat deposition and increased weight exert excess pressure on the spine, resulting in disc herniation. Because the lumbar spine is a relay station of the upper body, the lumbar discs are more prone to herniation, causing Sciatica.
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- Jobs and activities: Some jobs demand prolonged standing, strenuous activities involving turning and twisting, and prolonged sitting hours. All of this may increase spinal degeneration, consequently increasing the chances of a disc prolapse or spinal stenosis and Sciatica.
Sciatica Treatments
Sciatica treatment in Dubai depends on the severity of the sciatica, duration of symptoms, whether or not there is any associated weakness, and whether or not there is any associated bladder or bowel dysfunction.
If your sciatica is in its early stages, Dr Sherief recommends conservative approaches (medications or therapies) – assuming there is no significant weakness or bladder / bowel dysfunction. If medications and physiotherapy are not helpful, Dr Sherief may consider a ‘nerve root block’, also known as a transforaminal epidural, or surgery, typically in the form of a microdiscectomy or endoscopic discectomy.
Treatments available include:
Medications
- Anti-inflammatory medications
- Muscle relaxants
- Narcotics
- Certain anti-seizure medications
Physical therapy / physiotherapy
Dr Sherief may recommend a rehabilitation program in conjunction with a physical therapist to improve nerve-to-muscle coordination in the affected part and improve Sciatica. The program will include specific exercises to strengthen core muscles, improve posture and bring more flexibility.
Steroid injections
In some cases of extreme pain, Dr Sherief injects corticosteroid medication around the compressed nerve root. The injection typically requires a few days before the benefit is experienced. The injection serves to calm inflammation in the area down while the body eats away the disc prolapse. There are contra-indications to a transforaminal epidural which Dr Sherief will discuss with you as needed.
Surgery
Surgery is considered the last option for sciatica treatment in Dubai. That said, it is a highly effective operation, with very high patient satisfaction rates.
Dr Sherief will be more than happy to guide you through the various surgical options, including microdiscectomy, endoscopic discectomy, lumbar decompression surgery and more.
Surgery typically requires an over-night stay in hospital, and most patients are relieved of their pain instantaneously, with those having early surgery having the best outcomes.
Is there any risk of Sciatica surgery?
As with any surgical intervention, Sciatica surgery carries with it some risk, most of which is fortunately uncommon. You can read more about complications of spinal surgery here: