LEG PAIN – Sciatica and Spinal Stenosis

Sciatica is a term used to describe nerve pain originating from inflammation or compression of the sciatic nerve or sciatic nerve roots. The sciatic nerve runs from the lumbar spine down the buttock and back  of the leg to the bottom of the foot. Sciatica can be felt in any of these regions.

Other symptoms associated with sciatica could be numbness ,pins and needles or muscle weakness, difficulty walking, difficulty straightening the affected leg.

Sciatica can be acute or chronic and may recur with episodic flareups.

Causes of Sciatica

The most common cause of sciatica is a slipped or prolapsed lumbar disc which compresses a root of the sciatic nerve. Other causes of sciatica can be nerve compression due to wear and tear arthritis(spinal stenosis) or direct damage to the sciatic nerve.

Diagnosis

The diagnosis is often made on the grounds of the clinical history and examination. To accurately diagnose the cause of sciatica it is often necessary to perform a lumbar MRI scan.

Treatment

The initial treatment consists of anti-inflammatory painkillers or for more severe pain, stronger painkillers and anti neuropathic agents( such as antidepressants or antiepileptic treatments.)

Symptoms that persist for longer than six weeks should be seen by a pain or musculoskeletal specialist for consideration of an epidural steroid injection.

Physiotherapy with stretching and core strengthening is always an important part of long-term treatment.

At the Yorkshire clinic we offer access to all specialist diagnostic and treatment modalities including access to specialist physiotherapy teams.

Spinal stenosis

Spinal stenosis refers to the narrowing of the spinal canal or exiting root of the spinal nerves. This usually occurs slowly over a number of years, and is usually a result of wear and tear of the discs and lumbar vertebra.

The symptoms include sciatica, pain and weakness or numbness in the legs buttocks or calves. These symptoms are frequently made worse by walking or standing for long periods and can be relieved by sitting or bending forwards. Muscle cramping can be a feature.

Diagnosis

The diagnosis can be made from an accurate history of symptoms and is usually confirmed with a MRI or CT scan.

Treatment

Non-surgical treatment

A combination of analgesics, physiotherapy with posture management and stretching exercises are often the mainstay of treatment.

More severe symptoms may require more interventional management such as epidural steroid injections or Transforaminal epidural  injections. Although these are not curative treatments they often serve as the easiest and simplest treatment modality.

An effective x-ray guided epidural steroid injection can significantly reduce symptoms for up to 9 to 12 months.

At present despite epidural steroid injections being widely recognised as an effective treatment, they are not currently recommended by NICE as a treatment for spinal stenosis.

Epidural steroid injections have been shown as being as effective as spinal surgery for long-term outcome results for spinal stenosis.

Surgical treatments

Depending on the specific cause of spinal stenosis, surgery may be the recommended treatment if conservative treatment has failed.

Surgical procedures can vary from a simple procedure at a single spinal level to more complicated procedures involving multiple levels.

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