FAQs on Sciatica and Radiculopathy Treatment in Philadelphia

Pain that originates from the sciatic nerve and radiates down the buttocks, thigh, and leg is called sciatica. This condition, also called radiculopathy, arises from compression, irritation, and/or inflammation of the sciatic nerve.

How common is radiculopathy?

Not everyone with an aging spine suffers from radiculopathy. However, according to statistics, lumbar (low back) radiculopathy affects around 4% of the general population. Men are more likely to have this condition, especially during the 40s. However, the condition affects both genders equally later in life. Of those diagnosed with radiculopathy, around 20% develop symptoms that last for more than 6 weeks.

What is the cause of radiculopathy?

The sciatic nerve is the largest nerve in the body, and radiculopathy occurs when this nerve is affected. Radiculopathy is often caused by:

  • Herniated lumbar disc – With a herniation, the inner gel material of the disc protrudes out from the tough outer layer onto the sciatic nerve.
  • Spinal stenosis – Sciatica occurs with spinal narrowing from stenosis, bone spurring, and arthritis.
  • Spondylolisthesis – This condition causes on vertebra to move out of line and onto the one below. This causes impingement on the spinal nerve roots.
  • Advanced scoliosis – This can lead to constriction of one or more nerve roots.

What are the associated symptoms of radiculopathy?

The symptoms of radiculopathy vary from person to person. Associated symptoms include:

  • Weakness and numbness of leg on the affected side
  • Pain, tingling, and electric-shock sensations of the buttocks, leg, and/or foot
  • Cramping pain that shoots down the affected leg

Who is at risk for sciatica?

Sciatica affects certain people. Risk factors include:

  • Having a herniated disc
  • Age between 30 and 50 years
  • Increasing height
  • Family history of this condition
  • Having degenerative disc disease or spinal arthritis
  • Trauma to the spine
  • Bone spurring that causes spinal canal narrowing
  • Obesity
  • Having diabetes

How does the doctor diagnose radiculopathy?

In addition to conducting a detailed physical examination and taking a complete medical history, the pain management doctor may order some diagnostic tests. X-rays will produce images of internal bones, tissues, and organs on a film. Magnetic resonance imaging (MRI) scans use large magnets and a computer to produce detailed images of the spine and associated structures.

How is radiculopathy treated?

The treatment of radiculopathy depends on what is causing the symptoms. In addition, the doctor will consider what treatments have worked in the past and the patient’s willingness to improve. Options for therapy include:

 

  • Medications – Depending on all symptoms involved, medications used include anti-inflammatory agents (ibuprofen, naproxen, short-term steroids), analgesics (acetaminophen, Ultram, opioids), muscle relaxants (Robaxin and Flexiril), and antidepressants (SSRIs or amitriptyline).

 

  • Epidural steroid injection (ESI) – The doctor can inject the epidural space with a long-acting corticosteroid. This area lies between the spinal cord and the epidural sac that surrounds the cord. Most studies report a success rate of 90% with the ESI.

 

  • Facet joint injection (FJI) – The doctor can inject the tiny facet joints with a long-acting anesthetic. The medication goes directly onto the spinal nerves. The doctor may decide to inject more than one joint during a session. According to a recent research report, FJI offers short-term and long-term pain relief to patients with back problems.

 

  • Physical therapy – With physical therapy, methods of pain relief include electrical stimulation, ultrasound, massage, and heat/cold therapy. To improve spinal movement, the doctor will employ stretching and strengthening exercises.

Resources

Boswell MV, Colson JD, Sehgal N, Dunbar EE, & Epter R (2007). A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician,10(1):229-53

Lee JW, Park KW, Chung SK, Yeom JS et al. (2009). Cervical transforaminal epidural steroid injection for the management of cervical radiculopathy: a comparative study of particulate versus non-particulate steroids. Skeletal Radiology, 38(11):1077-82.

Radhakrishnan K, Litchy WJ, O’Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population based study from Rochester, Minnesota, 1976 through 1990. Brain. Apr 1994;117 (pt 2):325-35.

Tarulli AW, Raynor EM. Lumbosacral radiculopathy. Neurol Clin. May 2007;25(2):387-405. Cervical radiculopathy occurs at a much lower frequency than radiculopathy of the lumbar spine. The annual incidence is approximately 85 cases per 100,000 population.