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The Surgical Procedure

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My family doctor Dr. John Shelton found that a neurosurgeon rather than a back specialist best to treat this type of problem. He referred me to Dr. Lee Kesterson in Ft. Worth, Texas, who told me that he normally does surgery with an orthopedic surgeon who is familiar with the muscle structure of the hip.

The term sciatica basically means inflammation of the sciatic nerve. This nerve runs from below the base of the spine with branches down the leg branching into the foot. One nerve cell can be very slender but three feet long. When you have pain from the sciatic nerve there is usually something pressing or rubbing on it causing some sort of irritation. Nerves have the tendency to refer pain. Referral pain is when the irritation is in one place but you feel it elsewhere. For me, the source of irritation was in my hip but I could feel pain all the way down to my heel.

You need to figure out the origin of your pain. That is the site that is irritated. Here are some steps:

• Figure out if your problem is in your hip or back.
• Press or have someone press in the suspect areas. You might have to press pretty hard to feel through the muscles.
• The place that hurts with pressure is probably the source of pain.
• Have the doctor inject the area with lidocaine. If most of the pain subsides then this is probably the source.

Here are some things to discuss with your doctor to help give him/her a clearer picture of what might be going on:

• The pain seems to begin in my lower back. Yes/No
• The pain is to one side but also lower back. Yes/No
• The pain begins high at the top of my leg in my butt. Yes/No
• I have had the pain for ____ days/months/years
• It will go away and come back. Yes/No
• I had an accident or pulled something. Yes/No

Sciatic pain can be caused from a minimum of three areas and if you can pinpoint the origin it will help your doctor. The spine and muscles of the spine can compress the nerves. The sciatic nerve can be compressed by the piriformis muscle after it leaves the coccyx and you can have pain from a loose sacroiliac joint or pull on the greater trochanter. Hopefully with this information you can help your doctor understand where you are hurting.

Pain can occur in any of the regions highlighted with the word pain. In the sacroiliac joint the sciatic nerve is not directly involved but pain can still radiate down the leg due to misalignment. A last place that can cause pain is on the tip of the leg bone called the greater trochanter. This area can have muscle pulls that cause soreness. The sciatic nerve may not be pressed here but the pain can still be miserable.

There are times when you may have more than one of these areas irritated. This makes the pain much more difficult to diagnose but, hopefully with your doctor's help you can get to the bottom of it.