Does Sciatica Lead to Permanent Damage?

Sciatica from a pinched nerve affects 1% of Americans at any one point in time. That's well over 3 million people! It involves a burning, searing type of pain that goes down a person's leg, resulting from a herniated disc pushing on an individual's nerve root in either the lumbar or sacral part of the spine. Can it lead to permanent nerve damage?

The short answer is yes. The long answer is yes. Here's the explanation. If you take your finger and push on a person's nerve root while he is awake, it does not hurt. That would be a ridiculous experiment, but the point is the pain from sciatica does not come from the simple act of compression. It comes from the resulting inflammation of the compression.

The inflammation sparks up pain and it typically travels down the area where that nerve root supplies sensation. For L3 that's on the front of the thigh, for L4 it's past the knee on the front of the shin. For L5 it's past the knee on the side of the calf and foot, and for S1 it's on the back of the calf and also on the side of the foot and a bit on the bottom. The nerve root supplied regions vary a bit from person to person, and not everyone walks out of a textbook.

So a herniated disc is pushing on the nerve root, sparking up inflammation, and causing sciatica pain. It may also cause pins and needles and/or numbness. These symptoms are obviously annoying to patients, but do not mean surgery is necessary. With these issues the surgery becomes a quality of life decision.

If conservative treatments fail, surgery has approximately a 95% chance of taking away the pain. Even a successful surgery for pain relief may still not fix the numbness pain. A significant amount of patients have numbness that never goes away, even if the surgery was technically done perfectly. The vast majority of patients don't care as long as the pain is gone. If the numbness involves the bottom of the foot though, it may be exceptionally annoying.

This is a hard phenomenon to predict, and is not the fault of the surgeon. It's the fault of the person's body. If a person develops muscle weakness from the nerve root pinching, and it does not improve over 4 to 8 weeks, surgery should be considered. Why? The reason is that the longer the muscle weakness, such as a foot drop is watched, the higher the chance it will never get better after surgery. Even if the surgery is technically done perfectly as well.

Epidural injections may allow patients to avoid surgery. They may do 2 things by decreasing the inflammation around nerve roots that are compressed. They may alleviate pain, and potentially allow the muscle weakness to improve. So pat your pain doctor on the back if that happens, as surgery is not fun. It's typically uneventful, but does entail some minor risks.