Sciatica, also known as lumbosciatalgia, is the name by which we commonly refer to a sharp or subacute pain that radiates from the lower back down the leg.
Associated with age and very common in pregnant women, sciatica can appear at any point of the nerve pathway, from the spine to the foot, and often follows its path from the lumbar region through the buttocks and the back of the thighs to the calves.
Why does sciatica occur?
The sciatic nerve originates in the spinal cord, from the spinal nerve roots L4, L5, S1, S2, and S3, which emerge from the spine in the lumbar and sacral region and combine to form the sciatic nerve in the gluteal region.
When these nerve roots become irritated or compressed, the clinical symptoms of sciatica or lumbosciatalgia are triggered, causing pain in the lower back and in one or both legs.
Technically, sciatica is “a medical condition that involves radiculopathy caused by an injury to the lumbar nerve roots, with the most frequently affected being L5 and S1,” explains Dr. Juan Fernando Henares, head of the Pain Unit at Quirónsalud Alicante.
What are its causes? Are there risk factors associated with its appearance?
One of the main causes of sciatica is herniated disc, “which occurs when an intervertebral disc herniates or ruptures, putting pressure on the nerve roots.”
Age is another common cause of this type of pain.
“As we age,” Dr. Henares adds, “it is possible for the spine to experience a narrowing of the spinal canal, known as stenosis. This compression can affect the origin of the sciatic nerve. Some age-associated degenerative diseases such as osteoarthritis also contribute to the development of low back sciatica.”
Likewise, injuries to the spine from trauma or tumours can damage the spine and compress the sciatic nerve.
The same goes for Piriformis Syndrome: the piriformis muscle irritates the sciatic nerve if it becomes inflamed or too tight, producing what is called pseudosciatica (deep gluteal syndrome).
In this sense, the Quirónsalud Alicante specialist adds that being overweight and lack of physical activity increase the risk of developing lumbosciatalgia, “by exerting additional pressure on the spine”.
What are the symptoms of sciatica?
Although the symptoms of sciatica are different in each person, the most common are:
- Stabbing, burning, or constant pain that radiates from the lower back into the leg, and is usually made worse by sitting for long periods of time.
- Paresthesias. In other words, abnormal sensations in the affected leg, such as tingling, numbness or muscle weakness.
- Loss of muscle strength that makes it hard to move the leg or lift heavy objects.
On the other hand, and although sciatica always affects the lower limbs (legs), there is a similar injury in the upper limbs called cervicobrachialgia.
“This condition involves the neck and arms, being a cervical radiculopathy. Treatments usually require greater specialization due to the complexity of the cervical spine,” concludes Dr. Henares.
What treatment options are available for sciatica?
The head of the Pain Unit at Quirónsalud Alicante explains that the approach to sciatica can be carried out from three different perspectives:
- Conservative management. “It is recommended for most people with herniated discs, as up to 90% will be spontaneously ‘reabsorbed’. It includes rest, medication for pain and inflammation, and physical therapy to strengthen muscles and improve mobility.”
- Minimally invasive management. “Percutaneous treatments for herniated disc are minimally invasive medical procedures designed to relieve the pain and symptoms caused by a herniated disc without requiring open surgery. The procedure is performed through small incisions in the skin and generally has fewer complications and shorter recovery times than traditional surgeries.”
- Surgical techniques. “Among them, discectomy or laminectomy, with or without instrumentation. Although effective, they carry greater surgical and anaesthetic risk”.
Regarding the techniques used in the Pain Unit of Quirónsalud Alicante to treat sciatica, the specialist lists:
- Epidural injections. Medication is injected directly into the epidural space, usually corticosteroids with local anaesthetic and ozone or Platelet-Rich Plasma (PRP). The treatment helps reduce inflammation and relieve pain, is symptomatic and effective, and facilitates the patient’s rehabilitation.
- Infiltration of the nerve root or Dorsal Root Ganglion (DRG). This procedure locates the nerve root causing sciatica, usually compressed by a herniated disc, and then a corticosteroid, local anaesthetic, or PRP is injected into the area. The technique is associated with neuromodulator therapies, such as pulsed radiofrequency.
- Nucleoplasty. Also known as percutaneous disc decompression. It is a minimally invasive technique and indicated in patients with disc protrusions and lumbar or radicular pain. Once the needle is precisely placed on the intervertebral disc, a lesion is made with different types of energy (such as radiofrequency) to reduce pressure and relieve the patient’s pain. The aim is to modify the collagen of the annulous fibrosus and ablation of the pain receptors in the area.
- Intradiscal regenerative medicine. It consists of injecting stem cells (MSCs) or enriched plasma to relieve pain of disc origin. This type of therapy has been shown to improve the water content at the level of the disc and increase cell proliferation thanks to growth factors and cytokines such as PDGF, IGF-1, TGF-β and VEGF.
- Intradiscal Ozone Therapy. It involves injecting a mixture of oxygen and ozone directly into the herniated disc. Ozone is thought to reduce inflammation and stimulate tissue regeneration, which can relieve pain and improve function.
- Percutaneous Laser Therapy. A laser with different wavelengths (usually 980nm or 1470nm) is used to vaporize or decompress the herniated disc tissue. The procedure is performed through a small incision and has a very fast recovery time compared to surgery.
Is there a definitive treatment? What is the success rate of these interventions?
The Pain Unit at Quirónsalud Alicante focuses on minimally invasive treatments, mainly in regenerative medicine.
Some of its advantages are its anti-inflammatory power, its minimal adverse reactions or the preservation of the structure of the disc and, with it, the biomechanical stability of this anatomical segment.
“These treatments have similar success rates to open surgery (80-90%), but with fewer potential complications,” explains Dr. Juan Fernando Henares.
“The literature supports the effectiveness of these techniques, which offer considerable relief and improve patients’ quality of life through outpatient procedures. Each case is evaluated individually, and these approaches are prioritized before considering open surgery, which carries a higher risk and longer recovery time.”
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