After a back or spine work injury, sciatica is a diagnosis that can come up in your L&I claim. What is it? How does sciatica arise in workers’ compensation claims? For that, it helps to have a basic understanding of the anatomy of the spine. I’m certainly not a medical professional. But, over the course of my career, I had to perform research and listen to countless hours of medical testimony. From there, I developed a basic understanding of the anatomy of the human spine, common spinal conditions, and how sciatica can occur. This basic knowledge helps me understand what my clients are going through with sciatica.
Anatomy of the human spine
The human spine is our backbone. Technically, it is made up of 33 individual bones called vertebrae. These bones stack one on top of the other. In addition, the spine comprises of discs, nerves, and the spinal cord itself. This structure is often called the spinal column. It provides the main support for the upright human body. Moreover, it connects different parts of the musculoskeletal system. On top of being a support structure, the spine is also an important protective structure. The spinal column protects spinal nerves from injury.
What is the Vertebrae?
The average adult human spine is made up of 26 vertebrae. That’s because some of the vertebrae in the spine fuse as humans age. The vertebrae are small bones, which are stacked to form the spinal canal. The spinal canal is essentially a tunnel. The spinal cord and nerves run through the tunnel. Most of the vertebrae in the spine can move, which allows humans to sit, stand, walk, twist, and bend.
What are the Facet Joints?
Vertebrae bones have multiple segments. The segments towards the outer part of the spine are called lamina. Then, the inner segments abutting the spinal column are called the pedicles. For each vertebra, between the lamina and pedicle, there’s slippery cartilage called the facet joints. These cartilage joints allow the vertebrae to slide against each other. This movement allows for greater range of motion and spinal column stability.
The discs in our spine
The discs, also called intervertebral discs, are a type of cushion. Spinal discs have an outer ring. The ring is made up of fibrous cartilage that encases a jelly-like core called the nucleus pulposus. The nucleus pulposus is mainly composed of water, but it also contains collagen. In essence, the discs act as a shock absorber and cushion between each vertebra.
Spinal cord and nerves
The spinal cord is a group of important nerves. These nerves run through the spinal canal from the base of the skull to the low back. They connect the brain to the various muscle groups throughout the body. In short, the nerves conduct electric signals or messages between the brain and the rest of the body. In turn, these signals enable both sensation and movement. Smaller nerves branch out from the spinal column at various vertebral levels to carry brain signals throughout the body.
What are vertebral regions?
The spine is often categorized into different regions or levels. The area of the spine near the neck is called the cervical region. There are 7 cervical vertebrae. Medical professionals refer to them as C1-C7. The mid back area of the spine is called the thoracic region. There are 12 thoracic vertebrae, which we refer to as T1-T12. Finally, the low back is called the lumbar region. There are 5 lumbar vertebrae that we label as L1-L5.
Just below the lumbar vertebrae is the sacrum or sacral region. The sacrum comprises 5 fused vertebrae, which doctors call S1-S5. The sacral cord segments in this region of the spine are sometimes called the “Cauda Equina”. Just below the sacrum is the coccyx or tailbone. It consists of 4 fused vertebrae.
Spinal degeneration and L&I claim challenges
The spine supports the human body. It enables flexibility and movement in many directions. Furthermore, it protects the nerves of the spinal column. While the spine is impressive, it is not unfailing. The spine does have flaws. Notably, nearly every component of the spine is impacted by aging. Over time, the spine loses its normal structure and function. It becomes more susceptible to damage and injury.
Throughout my career, I’ve heard spinal degeneration called many different things. The terms doctors use include arthritis, degenerative disc disease, and degenerative spine disease. Sometimes, medical professionals call it degeneration, osteoarthritis, herniation and stenosis. Regardless of the specific diagnosis, spinal degeneration is incredibly common. In fact, I’ve heard medical doctors testify that degeneration in the spine can begin as early as the teenage years.
As the spine ages, common things that may occur include:
- Loss of bone density resulting in more brittle and breakable bones
- Formation of calcium deposits or bone spurs on the surfaces of the bones
- Decrease in cartilage hydration, which increase the likelihood of fraying or tearing
- Weakening of disc walls leading to compression, shape changes and leaking.
Spine work injury and general spinal injuries
In addition to weakening from natural aging, the human spine is also susceptible to injury. In turn, it can lead to sciatica diagnosis in your L&I claim. There are an infinite variety of ways the human spine can suffer an injury. For example, slip and fall, auto accident, bicycle and motorcycle accident, assault and gun violence, injuries that occur during childbirth, infectious diseases that attack the spine, sports injuries, and spine work injury. Depending on age, these spinal injuries can occur on top of natural degeneration. They can produce even greater symptoms. Common signs and symptoms of spinal cord injuries include numbness, paralysis, and swelling. Spinal work injuries can also cause difficulty breathing, loss of muscle control, weakness, loss of bowel and bladder function, and pain.
What is Sciatica?
The term sciatica generally refers to radiating pain down one or both legs. Usually, the cause is some sort of low back injury that impacts the “sciatic” nerves. The sciatic nerves branch out from the low back through the hips and buttocks. From there, they run down the legs. Generally, the sciatic nerves are the combination of spinal nerves originating at the L4-S3 level of the spine. With back work injury or spine workplace injury occurrences, workers usually report issues with the L3-S1 level of the spine.
Spine and low back work injury incidents are very common. They often occur as a result of:
- BLT injuries: injuries that occur from the combination of bending, lifting and twisting;
- Trips, slips and falls;
- Heavy equipment accidents;
- Automobile accidents;
- Assaults; and
- Occupational disease – repetitive use workplace injuries and degenerative conditions.
Sciatica diagnosis in an L&I claim
All these low back injuries can result in sciatica. Inflammation, disc herniation, injuries that cause narrowing of the spinal canal, formation of calcium deposits or spurs, damage to the foramen or other cartilage and ligaments, can put pressure on, impact and even damage the nerves on the low back.
Doctors may diagnose sciatica when the damage is within the L4-S3 and produces radiating pain or radiculopathy. Often, doctors diagnose sciatica based on certain clinical exam findings. However, many medical professionals prefer an MRI to confirm the diagnosis.
Treatment for sciatica in the L&I claim settings
Receiving a diagnosis of sciatica can be distressing for work injury claimants. The good news is that there are many effective treatment options. They don’t necessarily involve scary or invasive surgeries. In fact, L&I medical treatment guidelines require doctors to exhaust less invasive or conservative treatment options before considering extensive treatment. Therefore, the first common treatment for work injury claimants with sciatica is physical and massage therapy. It’s important to see if symptoms can resolve naturally. In fact, symptoms can improve by reducing inflammation, increasing mobility, and strengthening.
Sometimes, physical therapy is not successful. In such cases, doctors may request an MRI. Other times, the medical provider may recommend injections. Some injections can serve two purposes. They can help alleviate symptoms and help pinpoint the specific levels of the spine that are injured. For example, say you receive a pain reliever injection to the L4 disc. Moreover, assume it results in measurable pain relief. Therefore, it can help medical providers identify that symptoms originate from that level of the spine.
More invasive L&I claim treatment for sciatica after a work injury
In some cases, conservative treatment measures are unsuccessful. At that point, medical professionals can consider more invasive treatment such as surgery. To proceed, they will need an MRI and possibly an EMG. Even if they recommend surgery, under the L&I medical treatment guidelines, medical providers will likely start with less invasive surgery. For instance, a laminectomy or discectomy. These procedures clean up around the damaged area of the spine. In turn, it allows more mobility and for the nerves to be free.
Under the L&I medical treatment guidelines, only if conservative treatment fails, then medical providers can consider a major surgery like spinal fusion. That’s not always a good thing. Why? Because treatment will take a long time for less responsive and severe sciatica. This also means the L&I claim is likely to be longer and more complex.
In conclusion, sciatica refers to radiating pain in the low back. If you receive a sciatica diagnosis under your workers’ compensation claim, it is a good idea to have a basic understanding of the anatomy of the spine. That way, you can better understand your medical condition and the treatment recommendations. A diagnosis of sciatica does not necessarily mean you will need surgery. Also, it doesn’t mean long and painful recovery. Fortunately, many people recover successfully without surgery.
With sciatica, if your condition is more severe, you will need to be patient. Your treatment providers have to work through the various options, starting with more conservative ones. As you navigate your treatment, it is important to ask questions. Make sure you understand your diagnoses and treatment options. After that, make informed decisions. Finally, and throughout the process, track your body’s response to different treatments.