What Are the Treatments for Sciatic-Nerve Motor Deficit?

The sciatic nerve is the longest nerve in the body; it supplies both motor and sensory functions to the leg. Compression of the sciatic nerve results in a condition called sciatica which can manifest varieties of motor and sensory symptoms. While sensory symptoms can pose minor problems, motor deficit can significantly affect the quality of life of the person with sciatica. Treatments for sciatic-nerve motor deficits are widely available.

Significance

• The sciatic nerve provides both sensation and movement controls from the thigh down to the lower leg and soles of the feet. Any damage or injury to the sciatic nerve produces symptoms consisting of loss of motor movements and of sensation in the legs. The extent of injury may result in disability, with major symptoms of radiating pain, tingling or burning sensation, numbness, muscle weakness and loss of leg movement. The extent of the disability and symptomatic manifestations will depend on the extent of the nerve injury involved.

Causes of Injury

• The sciatic nerve may be injured due to nerve compression that may result from prolonged sitting, poor posture, pregnancy, herniated disc, spinal stenosis (narrowing of the spinal canal), spinal disc degeneration or fracture. (See ref. 2) The pyriformis muscle of the leg may also cause compression of the sciatic nerve. Hip surgery, tumors and intramuscular injection are risk factors that can damage the sciatic nerve.

Motor Deficits

• Minor injury of the sciatic nerve may result in muscle weakness but with a greater degree of nerve compression or injury, leg movement may be lost. The patient will experience foot drop and the inability to walk. Muscle atrophy may result due to a lack of movement of the leg and reflexes may be lost or weakened.

Conservative Treatment

• The initial management for sciatic nerve injury consists of conservative treatment involving pain management and physical therapy. Pain management consists of prescribed pain medications and muscle relaxants with the goal of improving the quality of life of the patient while healing takes place. Physical therapy consists of exercises to avoid muscle atrophy, prevent further muscle weakness, strengthen the legs and retrain the muscles. Rest, massage and application of ice or heat can relax the muscles and relieve the pain.

Surgical Treatment

• Surgery to relieve the motor deficits of sciatica is often indicated depending on the severity of the pain and the duration of the condition. Microdiscectomy is the option when four to six weeks of conservative treatment fails to provide relief of symptoms, muscle weakness is progressive and the patient has lost bowel and bladder control. Lumbar laminectomy is indicated if there is spinal stenosis and the patient manifests a significantly low level of activity.

Expert Insights

• Sciatic nerve injury may heal within a few days or weeks depending on the severity of the damage. Conservative treatment alone may provide relief from the motor deficits and can prevent the progression of the condition. The surgical option is relatively elective, taking into consideration the patient's tolerance to pain and the extent of how it affects the quality of life of the patient.