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Sciatica is pain resulting from irritation of the sciatic nerve. Sciatica pain is typically felt from the low back to behind the thigh and radiating down below the knee.

There may be numbness in the area, weakness in the leg and diminution of the reflexes. It is most often the result of a slipped or herniated disc, spinal stenosis (an overgrowth of bone in the spinal canal) or in extremely rare cases, infection or tumor. It is important to determine the correct cause of the symptoms prior to beginning treatment of sciatica.

It typically affects 30 to 50 year old patients. Often there is a sudden onset that may be attributed to over-exertion or a back injury.

Non-surgical treatment of sciatica

Over-the-counter drugs

Treatment is initially aimed at addressing the inflammation associated with sciatica. Rest and anti-inflammatory medications (such as Motrin or Celebrex) are often good to start with. Over-the-counter NSAIDs include acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve).

Prescription drugs

If you have chronic sciatica, you may need a muscle relaxant to help ease muscle spasms. Narcotics also may be prescribed for short-term pain relief. Tricyclic antidepressants and anticonvulsant drugs also can help ease chronic pain. They may help by blocking pain messages to the brain or by enhancing the production of endorphins, the natural painkillers. Some patients require a more powerful anti-inflammatory treatment and are given oral steroids (often called a Medrol Dose-Pak). These steroids do have potential side-effects, but the powerful anti-inflammatory effect can be helpful in the treatment of sciatica.

Epidural steroid injections

If the pain is severe and very disabling and cannot be controlled with simple painkillers and/or anti-inflammatory medication, an epidural injection can be given which soothes the nerves that are causing the pain. This procedure is similar to the epidural used during childbirth.

An epidural injection is different from oral medications because it injects steroids directly to the painful area around the sciatic nerve to help decrease the inflammation that may be causing the pain. While the effects tend to be temporary (providing pain relief for as little as one week up to a year), and it does not work for everyone, an epidural steroid injection can be effective in providing relief from an acute episode of sciatic pain. Importantly, it can provide sufficient relief to allow a patient to progress with a conditioning and exercise program.

Corticosteroids can have side effects, so the number of injections in a year should be limited to usually no more than three in one year. Also, it is important to note that this injection does not address the root cause of the problem.

Surgical treatment of sciatica

In most cases, sciatica can be treated with non-surgical treatment methods. However, there are a few situations when spine surgery may be considered as an option for the treatment of sciatica:
  • No sign of improvement in four to six weeks
  • No control of bladder or bowel movements , which could be a result of spinal cord compression
  • Lumbar spinal stenosis
  • Neurologic dysfunctions such as severe leg weakness
  • Worsening symptoms
  • Non-surgical treatments are not effective to alleviate symptoms
There are many types of surgical procedures used in spine surgery, and a spine surgeon is the person to recommend the best procedure to treat sciatica. The important point is that it is almost always the patient’s decision whether or not to have the surgery, and the surgeon’s role should be to help inform that patient of his or her options to help the patient make the best choice. Two common spinal surgeries for sciatica are:

Discectomy or microdiscectomy

In both of these procedures, the surgeon removes all or part of a herniated disc that is pushing on the sciatic nerve and causing the sciatica symptoms. The difference between the procedures is that a microdiscectomy is a minimally invasive surgery. The surgeon uses microscopic magnification to work through a very small incision using very small instruments.

Approximately 90% to 95% of patients experience relief from their sciatica pain after this surgery. Success rates of standard diskectomy and microdiskectomy are about equal, but there is less pain and recovery occurs more quickly with microdiskectomy.

Laminectomy or Laminotomy

Both these procedures involve a part of the spine called the lamina—a bony plate that protects the spinal canal and spinal cord. A laminectomy is the removal of the entire lamina; a laminotomy removes a portion of the posterior arch to relieve pressure on the affected nerve tissues. Ideally, most of the disk is left intact to preserve as much of the normal anatomy as possible. These procedures can create more space for the nerves, reducing the likelihood of the nerves being compressed or pinched. After a laminectomy, approximately 70% to 80% of patients typically experience relief from their sciatic nerve pain.

In cases of spinal stenosis, the portion of bone that is putting pressure on the sciatic nerve system can be removed.

It is important to give your body time to heal, so the doctor will probably recommend restricting your activities after surgery. Avoid driving, excessive sitting, lifting or bending forward for at least a month after surgery. The doctor may suggest some exercises to strengthen the back.

X Stop

In 2005 the FDA approved a new surgery designed to relieve symptoms of lumbar spinal stenosis called the X Stop. This procedure involves placing an implant in the very back of the spine that prevents the patient from leaning backwards, a position that typically causes pain in patients with lumbar spinal stenosis.

Simple steps to prevent recurrence of sciatica

Following are some simple suggestions to help reduce sciatica and reduce the chances of recurrence:
  • Regular exercise reduces the risk of sciatica. Proper posture relieves pressure on the low back that contributes to sciatica.
  • Avoid movements that involve extreme body rotation as it can lead to lumber disc herniation and sciatica thereafter.
  • Choose seating that supports the spine's natural curve and allows the feet to rest flat on the floor. 
  • Avoid sitting in awkward positions for prolonged periods of time. A good chair should comfortably support your hips, and the seat shouldn't press on the back of your thighs or knees. Make it a point to get up and walk around often.
  • Avoid lifting and carrying things that are heavy, bulky or awkward in shape.
  • Select a mattress and box spring that offers good support. Use pillows for support, but don't use one that forces your neck up at a severe angle. Slip a pillow under the knees to help relieve low back pressure. People who prefer to sleep on their side should place a pillow between their knees to help reduce hip and low back pain.