This article is part of a series written by Dr. Kevin Pauza
Symptoms of Sciatica
Due to the variable nature of sciatic pain, a wide range of symptoms can arise. Similar to herniated discs, sciatic pain is worse in, and radiates to, the legs, most of the time below the knee. However, this is just the tip of the iceberg. The following are some of the most common symptoms of sciatica.
- Constant pain in only one side of the buttock or leg.
- Pain that originates in the low back or buttock and continues along the path of the sciatic nerve – down the back of the thigh and into the lower leg and foot.
- Pain that feels better when lying down or walking, but worsens when standing or sitting.
- Pain typically described as sharp or searing rather than dull.
- A pins-and-needles sensation, numbness, or a prickling sensation down the leg.
- Weakness or numbness when moving the leg or foot.
- Severe or shooting pain in one leg, making it difficult to stand up or walk.
- Pain and other symptoms in the toes, depending on where the sciatic nerve is affected.
Other symptoms are more unique to specific kinds of sciatica. The two nerve roots which exit the spine (L4 and L5) and begin the nerves in the legs have their own associated problems.
How Sciatica is Diagnosed
MRIs possess little ability to identify sciatica’s underlying cause because the annular tears and leaking nucleus pulposus that causes inflammation can’t be seen on MRIs. MRIs only see disc herniations, bulges, and degeneration, but this is irrelevant because herniations, bulges, and degeneration are not the true cause of sciatica. It is the leaking nucleus pulposus gel invisible to MRIs that causes sciatica.
History & Physical Exam
MRIs should not be used to diagnose sciatica, because sciatica is most accurately diagnosed through the patient’s history and physical exam. The exam is simple: raise your leg at your hip beyond 30 degrees, and if it causes leg pain, it’s sciatica. This can be determined by lifting the leg because this movement stretches the sciatic nerve root and if the root is inflamed, it will cause pain when stretched. If it’s not inflamed, it will not cause pain when stretched, indicating that the issue is not sciatica.
Additionally, your doctor also easily tests for skin sensory loss, muscle weakness in muscles innervated by the sciatic nerve, and reflex loss in the tendons attached to muscles innervated by the sciatic nerve.
EMG & Nerve Conduction Test
EMG tests are rarely necessary or appropriate for diagnosing sciatica. EMGs do not add any value because the diagnosis is readily established through a patient’s history and a physical exam.
Some still mistakenly believe EMGs differentiate between compression nerve injury and inflammation nerve injury, but this is incorrect. The EMG’s value is only in identifying concurrent nerve pathologies or rare muscle or nerve disorders such as ALS or Gullian Barre. Again sciatica is more readily diagnosed through history and physical exam.
Discograms provide no information to improve patient outcomes. No publications establish the ability of discography to diagnose sciatica or improve treatment outcomes of any spine disorder. If one is asked to undergo discography, query the referring surgeon for facts to validate its clinical utility.
Annulograms identify annular tears within the 22-25 annular layers. These layers contain all of the disc’s sensory pain nerves. Annulograms possess high diagnostic value to identify annular tears and direct the optimal treatment.
Annulograms are precise, safe, and painless, but are rarely necessary because a physical examination will most likely provide the diagnosis. However, annulograms can be performed when the precise diagnosis escapes physicians, all prior tests were negative, or prior surgical discectomy or fusion failed.
Regardless of how your sciatica is diagnosed, there is a truly restorative and regenerative treatment available for this condition. The Discseel® Procedure is a promising biologic treatment that is minimally invasive and non-surgical.
First, the spinal discs causing the sciatica are pinpointed through the use of an annulogram, the steps to reverse the damage are taken. During the Discseel® Procedure, fibrin biologic is applied in the torn spinal discs, sealing them from continued leaking and providing them with the ability to regrow tissue, healing the annular tears. This allows sciatica pain to be healed, by stopping further irritation of the nerve causing pain. The best part is that, regardless of where the procedure is performed, most patients are up and walking in 24 hours and your mobility will not be limited once you’ve fully healed.
If you’re ready to stop living with pain, apply for the Discseel® Procedure today and find out if you’re a candidate.
Feature image attribution: photo created by jcomp – www.freepik.com