Severe, Persistent Sciatica: Understanding Your Treatment Options

Sciatica is an injury or irritation to the sciatic nerve in your lower back. It produces pain, tingling, weakness, and/or numbness down your back, into your buttocks, and down the sides of your legs. While sciatica can be mild and annoying, severe cases can be debilitating and require treatment.

At Interventional Pain Center in Legacy Office Park, Norman, Oklahoma, interventional pain medicine physician Dr. James Stephens offers treatments for back pain, including sciatica. If you’re experiencing symptoms that interfere with your daily activities, here’s what you need to know about your treatment options.

The sciatic nerve and sciatica

The sciatic nerve is both the longest and the thickest in your body, up to two centimeters wide, or the width of a penny. Despite its name, though, it’s not a single nerve. It contains a bundle of nerves that originate from five nerve roots that branch off from the spinal cord.

There are actually two sciatic nerves, one on each side of your body. They extend from the lower back through the hip and buttock on one side, then travel down the leg on their side of the body until just below the knee.

At that point, they split into other nerves that connect to the lower leg, foot, and toes. That means it’s possible to experience symptoms from your back to your toes.

In extremely severe cases, you can experience urinary or fecal incontinence, as the signals that control your bladder and bowels don't reach their destinations.

What causes sciatica?

Anything that presses on the sciatic nerve or the nerve root in the spinal cord can lead to sciatica. Some common conditions that cause sciatica include:

• Herniated discs
• Degenerative disc disease
• Spinal stenosis (narrowing of the spinal canal)
• Foraminal stenosis (narrowing of the opening where the nerve exits the canal)
• Osteoarthritis
• Bone spurs (bony growths from friction)
• Injuries
• Pregnancy
• Tumors, cysts, or other growths

You’re also more at risk if you’re overweight or obese, as the extra mass can press down on the sensitive nerve or root.

Treating sciatica

Sciatica, once it gets started, rarely goes away on its own, but it can be treated with conservative options or with minimally invasive surgical solutions, depending on the severity of your symptoms.

Conservative treatments

Most cases of sciatica respond well to conservative treatments, and that’s where we start. Our goal is to target both your symptoms and the underlying problem(s). Some types of treatment include:

• Oral medications 
• Epidural steroid injections in the spinal canal reduce inflammation
• Pain-relieving injections
• Radiofrequency ablation (burn off the nerve ending so it can’t sense pain)
• Nerve blocks

We also provide referrals for physical therapy, which combines stretches and strengthening exercises that help your body regain its former strength and range of motion. If the pain is too severe to do the exercises, we may opt for an epidural steroid or other pain-relieving injection that can reduce your symptoms enough for you to participate in the program.

Minimally invasive surgical treatments

If you have severe sciatica and conservative treatments aren’t effective, you may need a minimally invasive surgical approach. Dr. Stephens offers three good options:

1. Laminectomy

This procedure addresses problems such as bone spurs or spinal stenosis. Dr. Stephens removes the part(s) of the vertebra(e) causing the symptoms, alleviating pressure on the nerve, relieving pain, and restoring your range of motion. 

2. Microdiscectomy

Here, Dr. Stephens trims part of a herniated disc that’s exerting pressure on your sciatic nerve or removes the disc entirely, offering relief.

3. Vertiflex™ Superion®: indirect decompression

The Vertiflex procedure helps patients whose sciatica results from lower lumbar stenosis (LSS) that impinges on the nerve. It's clinically proven to offer long-term relief from the back and leg pain associated with both LSS and sciatica. The data from patients, who experienced successful outcomes for up to five years after surgery, support the procedure's results.

Are you struggling with severe and persistent sciatica? Interventional Pain Center can help. To learn more or schedule a consultation with Dr. Stephens, call the office at 405-759-8407 or use our online booking tool today.