Sciatica (Lumbar Radiculopathy)

Lumbar radiculopathy more commonly known as sciatica means a radicular pattern of pain, which arises from the back of the hip and goes into the leg in a specific pattern. Sciatica literally means along the pain caused due to the sciatic nerves. Sciatica is a term used for the pain, which arises from the thigh due to the compression of the nerve roots.

The sciatic nerve is formed by the combination of nerve roots from L4 to S3 from the lumbar spine. Compression of any one of those nerve roots can lead to a typical pattern of symptoms. The most common cause of sciatica is disc degeneration and herniation. Though the most common cause of sciatica is compression of the nerve root from the back, it can also be caused by other problems affecting the sciatic nerve.

This pain may or may not be associated with tingling or numbness. Rarely, this can be associated with weakness, gait abnormality, imbalance, bowel or bladder involvement.

Axial section of the Lumbosacral MRI at L4-L5 level.

Axial section of the Lumbosacral MRI at L4-L5 level.

Sagittal section of the lumbosacral on MRI.

Sagittal section of the lumbosacral on MRI.

 

Presentation Or Symptoms Of Sciatica

Sciatica presents by the typical pattern of pain going down either from the outside of the thigh and leg into the top of the foot or from the back of the thigh and leg into the bottom of the foot due to involvement of L5 or S1 respectively. It can occasionally present with pain along the side in front of the thigh bone into the inner side of the front of the leg due to the involvement of the L4 nerve root.

It can rarely present with pain along the front of the thigh if it involves the nerve roots of L2 or L3. Though these nerve roots are not part of the sciatic nerve, the pain is still referred to as sciatica.

These pain can similarly be associated with tingling and numbness in specific areas, which are supplied or innervated by these nerve roots.

Pain affecting the nerve roots of L2, L3 can also weaken the hip joint. Similarly, pain and sciatica involving the nerve roots of L2, L3, L4 can cause weakness of the knee also. Nerve roots involving L5 and S1 can cause weakness in the ankle.

The weakness can lead to limping or stumbling with loss of balance. Patients may have to use a crutch or a cane to maintain their balance. They may be unable to walk up and down the stairs or get in and out of the car. They may have difficulty getting up from the chair or from the ground.

Rarely, these patients may have involvement of bowel or bladder in which case they may not be able to control the process of defecation or urination and may have incontinence. They may also have decreased sensation in their perigenital areas.

Diagnosis

A diagnosis of sciatica is a clinical diagnosis. Patients have a typical presentation, which is not commonly associated with any injury or fall. These patients may have had symptoms of back pain at the time of presentation or in the past. Sometimes, the patient may have no back pain at the time of the presentation.

X-rays are usually done on their first visit to look for any gross abnormality and rule out any instability. Patients are usually treated with conservatively means initially. Patients may also need to undergo advanced imaging like MRI to confirm the diagnosis.

Occasionally, patients who have confusing symptoms or may have comorbidities like diabetes or other neuropathies may need to undergo nerve conduction study and electromyographic studies.

Treatment and Management

The initial treatment for sciatica is conservative treatment, which includes medications and physical therapy. Anti-inflammatory medications, as well as pain medications along with some neuro-behavior modifying medications, can be used for suppressing the pain.

Physical therapy can be done by the patient at home, but has better results with outpatient physical therapy. The therapy is centered around stretching as well as strengthening the core muscles of the back. These include the muscles of the front and the back of the torso. Also, physical therapy for hip and knee muscles is performed. Patients are also helped with gait especially those who have a weakness.

Patients who do not get better with these conservative means can undergo nerve root block or epidural injection. These cortisone injections are directed to the nerve root which is irritated and inflamed. These injections help with decreasing the inflammation and hence decreasing the pain.

If the compression is not severe, our human body is capable of taking care of it in the due course of time. The patients who have recurrent pain can either have repeat injection or may need surgical management depending on the recurrence and severity.

Surgery is performed for patients who do not get relief with either conservative management or injection over 4 to 6 weeks. Sometimes, the patient may have acute worsening of the neurological status or involvement of bowel or bladder. These patients as well as those who have severe pain, which is not relieved by medication, may need urgent surgical management. Patients who have involvement in bowel or bladder may present with cauda equina syndrome, which is an emergency.

Surgery involves decompressing the nerve roots and removing the pressure from the nerves. Usually, this can be done in a minimally invasive fashion. Small incisions were used to reach the nerve root from the back. The bone and the redundant ligamentous tissue from over the nerve root is removed. If the compression is over more than one nerve root or on both sides then similar surgery is performed on all the levels. Occasionally, patients may have instability in the vertebral segment in such cases a fusion surgery may be required.

Recovery

90% of patients do well without surgery. Patients who are treated with or without surgery for sciatica usually do well in the long term. They may have a recurrence of pain either at the same level or adjacent levels due to ongoing aging and wear and tear. Such presentations are again treated in a similar fashion. Patients who undergo surgery usually get better in 3 to 6 weeks. Patients who undergo fusion surgery may take a little longer for recovery.

Prognosis

Overall, the treatment of sciatica has a good prognosis. Patients have good relief having been treated with or without surgery. Pain is relieved relatively early in the treatment course. Patients who have numbness and weakness may take more time and may have incomplete recovery. Patients who have involvement of bowel and bladder if treated urgently may have a good recovery.

Conclusion

Sciatica is a life-affecting disease process, which frequently needs treatment. 90% of patients can do well without surgery. The recovery from surgical or nonsurgical treatment is good. Patients will have consistent and good relief of pain. Patients may have residual back pain or incomplete recovery from numbness or weakness.

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Based on 107 reviews
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
Dave
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
Eclectic54
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
Sam
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
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I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.