Yes, an orthopedic doctor is highly qualified to treat sciatica, particularly when the pain originates from a structural issue within the spine. Sciatica is not a diagnosis itself but a symptom, defined as pain that radiates along the path of the sciatic nerve, typically from the lower back down one leg. An orthopedic specialist focuses on the entire musculoskeletal system, including the bones, joints, and nerves of the spine, making them experts in addressing the physical causes of this nerve compression.
The Orthopedic Focus on Sciatica
The expertise of an orthopedic doctor is ideally suited to managing sciatica because the majority of cases arise from mechanical problems in the lumbar spine. These specialists understand that the radiating pain is often a direct result of a compressed or irritated sciatic nerve root in the lower back. Common structural causes include a herniated or bulging intervertebral disc pressing against the nerve, or spinal stenosis, which is a narrowing of the spinal canal.
Other mechanical issues, like bone spurs (osteophytes) or a condition called spondylolisthesis, where one vertebra slips over another, can also pinch the nerve roots. This detailed knowledge of spinal anatomy and biomechanics allows them to create a targeted treatment plan, whether it involves conservative care or surgical intervention.
Pinpointing the Cause: Diagnostic Procedures
An orthopedic doctor begins the diagnostic process with a thorough physical and neurological examination to isolate the source of the nerve irritation. During this examination, the doctor will assess the patient’s reflexes, muscle strength, and sensation in the legs and feet to identify any signs of nerve damage. A specific maneuver, such as the straight leg raise test, may be performed to see if lifting the leg reproduces the characteristic radiating sciatic pain, which strongly suggests nerve root compression.
To gain a clear view of the spinal structures, imaging tests are often ordered to confirm the physical findings. X-rays can reveal structural issues like bone spurs or changes in the alignment of the vertebrae. Magnetic Resonance Imaging (MRI) is considered the best tool for visualizing soft tissues, providing detailed images of the spinal cord, nerve roots, and intervertebral discs.
In some complex cases, a Computed Tomography (CT) scan, sometimes combined with an injected dye, may be used to enhance the visibility of the nerve roots and bony structures. Electromyography (EMG) and nerve conduction studies (NCS) are functional tests that measure the electrical activity of the nerves and muscles. These diagnostic steps are crucial for accurately determining the root cause and guiding the most effective treatment strategy.
Non-Surgical Management Strategies
For the majority of sciatica patients, an orthopedic specialist will initiate treatment with conservative, non-surgical management strategies. The immediate goal is to reduce inflammation and alleviate the pain to allow the body to begin healing. Medication management often includes nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease swelling around the nerve root, or prescription muscle relaxants to ease muscle spasms.
If the pain is severe and not responding to over-the-counter options, the doctor may prescribe nerve pain medications, such as gabapentinoids. A frequent and effective component of conservative care is a referral to physical therapy, where a customized program focuses on improving strength and flexibility. Physical therapists use specific exercises to strengthen the core muscles that support the spine, improve posture, and stretch tight muscles like the hamstrings and piriformis.
When pain persists, orthopedic doctors may recommend therapeutic injections, most commonly an epidural steroid injection (ESI). This procedure involves injecting a corticosteroid medication directly into the epidural space near the irritated nerve root. The steroid acts as a powerful anti-inflammatory agent, providing relief that often creates a window of opportunity for physical therapy to be more effective. Up to 90% of individuals with sciatica improve with a combination of these conservative measures within a few weeks to months.
Surgical Intervention and When It Is Necessary
Surgery is considered by the orthopedic surgeon only after a comprehensive trial of non-surgical treatments, usually lasting between six to twelve weeks, has failed to provide adequate relief. The primary indicators for moving to an invasive procedure are persistent, debilitating pain that severely restricts daily activities, or the onset of progressive neurological deficits. These deficits can include worsening muscle weakness, foot drop, or increasing numbness in the leg.
An urgent surgical intervention is required if the patient develops cauda equina syndrome, a rare but severe condition characterized by new-onset loss of bowel or bladder control. For cases where surgery is necessary, the orthopedic surgeon will perform a procedure directly addressing the structural cause of the nerve compression. A microdiscectomy is a common, minimally invasive procedure used for a herniated disc, involving the removal of the specific disc fragment pressing on the nerve root. If spinal stenosis is the cause, a laminectomy may be performed, which removes a small portion of the bone (the lamina) from the back of the vertebra to create more space for the nerves.