We often hear the term “pinched nerve” in reference to someone suffering from leg pain or back pain. A more appropriate term is “sciatica,” since this term refers to the symptoms of a lumbar nerve being pinched or compressed.
The lumbar spine or lower back, which serves as a conduit of the spinal cord, is made of five vertebrae and their intervening discs. The nerves run close to the lumbar disc and therefore at risk for any changes in the disc.
Because of this configuration — vertebral body, lumbar disc, vertebral body, the lumbar spine is flexible and allows us to bend our torso to sit, pick up things from the floor, and so on. But because of this flexibility, there is increased wear and tear on the lower back leading to injury and arthritis in the lower spine.
It is these events — injury or arthritis — that might lead to a nerve in the lower back being pinched or compressed. Oftentimes, the pinching of the nerves happens where the nerves cross the disc on its way out of the spinal canal.
When the nerve is pinched, then any function the nerve serves can be affected. As such, patients will and can complain of many symptoms, of which the following is only a partial list: sharp shooting pain down the leg, burning sensation in the leg, dull achy pain, back pain, weakness in the leg and foot, increased pain with walking.
The onset of these symptoms can be sudden and can result from a fall, to even simply bending over to pick up a piece of paper. Other times, the symptoms are more gradual in onset and can slowly worsen over time.
Patients often seek medical attention when the symptoms are so severe it affects their quality of life and limits their ability to do the things they like or want to do. Sometimes, patients seek medical attention when they develop weakness in their leg or foot. This is a special circumstance and is called, drop foot.
A drop foot is the result of severe compression of one of the nerves that goes from the lower back to the muscle in the leg, which pulls up the foot as we walk. With a drop foot, patients will notice that their foot will slap the floor as they walk since they are too weak to pull their foot up as they walk.
This condition can be considered a surgical emergency, since it indicates a sudden loss of nerve function, which can only be treated by taking the pressure/compression off the nerve.
If symptoms of a pinched nerve are more gradual and the patient does not have a foot drop, then the patient can initially be treated with medications, therapy, chiropractic care, and epidural injections.
All these treatments are to allow the nerve to recover and for the symptoms to resolve themselves. Most patients will respond well to these treatments, with a minority who do not and require further evaluation with X-rays and an MR scan.
An MR scan uses magnetic waves to look into the body to provide a picture of which nerve is being pinched and by what, and how severely. Based on this study and how well the patient has responded to medications and treatment, additional treatment can be recommended.
Sometimes, despite all the treatments listed above, some patients’ symptoms do no improve, or even worsen. It is in these patients, that surgical treatment is recommended.
The surgical treatment is an outpatient procedure called a micro-laminectomy, or micro-discectomy, which allows the patient to go home the same day as the procedure.
The goal of this procedure is to remove the pinching on the nerves, thereby allowing the nerve to return to its normal function and for improvement of the symptoms whether there is burning pain or even a foot drop.
In summary, most patients with sciatica respond well to medications, PT, chiropractic treatments and epidural injections. A minority of patients will require an outpatient procedure called a micro-discectomy to resolve their symptoms.