Sciatica is a type of nerve pain that my team and I repeatedly hear about from our auto accident clients. It is also known as lumbar radiculopathy. Below, I outline this condition, what causes it, treatment options, and similar conditions.
What is sciatica?
Sciatica is pain that runs down the back of the leg. It is named after the sciatic nerve, a nerve that originates in the lower lumbar spine and then travels down the back of both legs. Sciatica pain is felt all along this nerve, from the lower back, to the pelvis, hips, and buttock, and to the thighs.
This pain is usually described as shooting jolts of pain, and sometimes as a burning pain. Sitting or standing in one place for a long time or certain movements, such as twisting, may cause more severe pain.
What causes sciatica?
Car accidents commonly cause nerve damage because the sudden stop or change in direction causes injuries to the spine. These injuries are often minor enough that they don’t immediately seem problematic, but they may result in nerve pain that can last for months or years in severe cases. Sciatica after a car accident may be a symptom of one of the conditions described below.
A disc herniation, also known as a slipped disc or bulging disc, is a common car accident injury.
What is a herniated disc?
The spine is a column of bones called vertebrae. These bones provide structural support and protect the spinal cord. Spinal nerves branch out from the spinal cord, providing sensation and function to the rest of the body. In between the vertebrae are spinal discs, also known as intervertebral discs.
The role of these discs is to act as shock absorbers. They cushion the spine from the impact of walking, twisting, jumping, and all of the other movements we do every day. In a traumatic event, such as a car accident, the discs can rupture.
When this happens, the liquid center of the disc bursts out. If this material touches one of the spinal nerves, it can irritate and inflame the nerve, resulting in pain and numbness that radiates along that particular nerve. A herniated disc located in the lower back can irritate the sciatic nerve roots, causing sciatica.
Degenerative Disc Disease and Spinal Stenosis
As we age, our spines suffer some wear and tear. Car accidents can cause deterioration due to the wear and tear of age to suddenly worsen and cause symptoms that were not there before. Lawyers call this aggravation of a preexisting condition.
Degenerative disc disease is the term used to describe the effect that aging has on the spinal discs. Over time, the discs both dry out and crack, weakening their ability to cushion the spine against everyday movements and traumatic events like car crashes, potentially resulting in a herniated disc.
Another symptom of degenerative disc disease and aging is spinal stenosis. Stenosis is the narrowing of the spinal canal, the hollow part of the vertebrae that houses the spinal cord. How does this happen?
As the spinal discs weaken, the body attempts to strengthen and stabilize the spine by growing tough ligaments. These thickened ligaments in turn grow bone spurs. Both the thick ligaments and the new bony growths protrude into the space in the spinal canal, potentially putting pressure on spinal nerves and causing symptoms like sciatica.
Spondylolysis and Spondylolisthesis
Spondylolysis is a term used to describe a stress fracture in one of the vertebrae of the lower back. Specifically, this term refers to a stress fracture in the pars interarticularis, the weakest part of the vertebrae. When the stress fracture causes the vertebra to slip out of place, this condition and its symptoms are called spondylolisthesis.
The further the vertebra slips forward, the worse pain the person will generally feel, and the worse the damage will probably be to the nerves. While herniated discs can occur even in low-speed car accidents, fractures typically happen in more forceful, higher speed car accidents.
How is sciatica treated?
Most of the conditions described above that cause sciatica can be treated conservatively in mild cases. This means that the symptoms can be greatly reduced or cured with a combination of physical therapy, medications, and epidural injections.
A physical therapist works with the car accident victim to strengthen the body and improve posture, relieving pressure on the lumbar spine. Nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen are used to reduce pain and inflammation. Epidural injections are another option for pain and swelling reduction. These injections of a corticosteroid into the spine provide long term relief.
Degenerative disc disease and spinal stenosis are irreversible because of their relation to aging. However, the root of the sciatica pain can still be addressed with the above treatments.
In more severe cases, and especially if one of the vertebrae is fractured, surgery may be needed to relieve sciatica. With a herniated disc, surgeons remove the portion of the ruptured disc that is touching the nerve root.
For spinal stenosis, the car accident victim may receive a titanium implant that prevents them from bending backward and aggravating the stenosis, or they may undergo a laminectomy. In a laminectomy, the surgeon removes the portions of the vertebra and the bony spurs that are affecting the nerve.
Finally, with severe spondylolisthesis, surgeons need to address the fracture and stabilize the spinal column. This may involve using rods, screws, or a bone transplant to add structure and hold the spine in place.
What else might be causing my pelvic and leg pain?
Sciatica is caused by the pinching of the spinal nerves. Some other conditions feel similar to sciatica but have a different origin.
One of these conditions is peripheral artery disease. Commonly caused by cholesterol and fat buildup in the arteries, this disease blocks blood flow to the extremities. Also, damage to the smaller, peripheral nerves in the leg mimics sciatica, though the nerve damage does not stem from the spine.
Another such condition is sacroiliac joint dysfunction. The sacroiliac (SI) joints connect the pelvis to the sacrum, the part of the spine below the lumbar spine. The inflammation of one of these joint results in lower back and leg pain. Finally, piriformis muscle spasms may mimic sciatica. The piriformis is a muscle in the buttock.
Some more serious, albeit very rare conditions that may feel like sciatica are spinal infections, tumors, and cauda equina syndrome (severe compression of lower back nerves). These problems can be fatal or paralyzing, meaning that it is extremely important to see a medical professional if you are experiencing sciatica pain, numbness, or weakness.
Recent sciatica medical studies
Surgery versus Conservative Care for Persistent Sciatica Lasting 4 to 12 Months by Chris Bailey et al., New England Journal of Medicine, March 2020.
Some sciatica is acute—it begins when the back injury occurs and stops soon after. Other sciatica lasts for multiple months. Researchers in this study wanted to know what treatment works best in patients with chronic pain. They screened 790 patients with a lumbar disc herniation and sciatica lasting 4-12 months. They found that surgery, specifically a microdiscectomy, was the most effective treatment.
Lumbar high-intensity zones on MRI: imaging biomarkers for severe, prolonged low back pain and sciatica in a population-based cohort by Masatoshi Teraguchi et al., The Spine Journal, March 2020.
MRI is a type of imaging that is used to locate the source of sciatica and guide how it can be treated. High-intensity zones show up as bright white on the scan, and their significance is debated. The researchers in this study found that high-intensity zones on MRIs are linked to longer-lasting sciatica pain.
Diagnosis and treatment of sciatica by Rikke Jensen et al., BMJ, Nov. 2019.
This is an overview of practice guidelines for the diagnosis and treatment of sciatica from top researchers in the field. The main points are, first, that sciatica is a symptom of several conditions. It is characterized by pain radiating down one leg. Surgery is not necessary for most patients, for whom physical therapy, exercise, and pain management helps with symptoms until the condition improves. To diagnose sciatica, imaging is only needed if the patient asks for it, if the symptoms persist for longer than 12 weeks, or if they worsen. Urinary retention and decreased anal sphincter tone are signs of cauda equina, an emergency situation. Surgery can be used to speed up recovery in patients who not improve after 6-8 weeks.