The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency.
Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc).

The first steps to deal with a herniated or prolapsed lumbar disc are conservative. These include rest, analgesic and anti-inflammatory medication and in some cases physical therapy. At this point, it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine.

If in a few days these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc, the space behind it and in the first case, the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.

Once the diagnosis has been confirmed, one of the best alternatives existing today is the Ozone Discolysis as the results obtained are excellent and practically has no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. In most patients left with painkillers as the only treatment, the symptoms eventually disappear, only that this could take weeks to months. Ozone speeds up these developments, see the same result in a few weeks. The problem has to be seen and approached integrally and frequently the combination of therapies has to be used, most frequently physiotherapy. Also, it has to be known that those who had a herniated disc have 10 times more chances of having another herniation than the rest of the population.

If despite the ozone therapy the symptoms persist, Drill Discectomy/ Laser Discectomy are good alternatives before open surgery (Discectomy) which has to be contemplated in those true emergencies, as mentioned above, this is possibly the first choice.

Once the conservative treatment fails:

Early aggressive treatment plan of pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only 5% of total LBP patients would need surgery & 20% of discal rupture or herniation would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then.

Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon pt`s pathology & response to treatment.

Using precision diagnostic & therapeutic blocks in chronic LBP, isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed.

LESI: Lumbar Epidural Steroid Injection

Indicated in   Acute radicular pain due to irritation or inflammation.

Symptomatic herniated disc with failed conservative therapy
Acute exacerbation of discogenic pain or pain of spinal stenosis
Neoplastic infiltration of roots
Epidural fibrosis
Chronic LBP with acute radicular symptoms
Epidural- lumbar injection
ESI Treatment Plan

Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.Drugs are injected total 6-10 ml at lumbar, 3-6 ml at cervical & 20+ ml, if caudal approach is selected. Lumbar ESI is performed close to the level of radiculopathy, often using paramedian approach to target the lateral aspect of the epidural space on involved side. Cervical epidural is performed at C7-T1 level.

SNRB- Selective Nerve Root Block 

Fluoroscopically performed it is a good diagnostic & therapeutic procedure for radiculopathy pain if

There is minimal or no radiological finding.
Multilevel imaging abnormalities
Equivocal neurological examination finding or discrepancy between clinical & radiological signs
Postop patient with unexplainable or recurrent pain
Combined canal & lateral recess stenosis.
To find out the pathological dermatome for more invasive procedures, if needed
Intradiscal Procedures 

Provocative Discography - Coupled with CT

A diagnostic procedure & prognostic indicator for surgical outcome is necessary for the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines.

Percutaneous Disc Decompression (PDD)

After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed

Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. The total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost.

Dekompressor: A mechanical percutaneous nucleosome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression.

Epidural Adhenolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS)

A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.

Procedures That Can Help Treat Slip Disc & Sciatica!

Exercises for Sciatica
Sciatica is often distinguished not as a medical condition but as a set of symptoms that underlie a more serious medical concern such as a slipped disc, degeneration of the spine or the lumbar region etc.
It is important to note the symptoms of Sciatica, as these are quite distinct -
1.Constant pain in one of the buttocks or leg (rarely are both legs affected)
2.The pain worsens on sitting
3.The pain is often described as a sharp & searing pain similar to a burning sensation
4.The pain is often accompanied by a heaviness or numbness that makes movement difficult
5.Shifting of postures (sitting to standing and back to sitting) becomes painful and laborious
An alternative to surgery would be to supplement the oral medication with certain specific exercises.
Reflexology, Acupuncture and Chiropractic manipulation are all considered effective to alleviate the pain to a large extent.
Patients are often encouraged to partake in daily exercise routine, incorporating strengthening and stretching exercises.
The strengthening exercises target the core or abdominal muscles along with the back muscles to provide more support to the back.
The stretching exercises will help to “loosen up” the surrounding muscle groups such as the hamstrings, which then allow for more blood and oxygen circulation alleviating the pain and giving the immune system a much needed boost.
When patients engage in a regular programme of gentle stretching and strengthening exercises, they can recover quickly (in comparison to those who do not exercise) from the flare ups and over time the painful episodes are known to reduce significantly, both in frequency as well as intensity.
Ancient holistic practices such Yoga and Tai-chi are often considered the best form of exercises for the afflicted because of the balanced and slow but controlled movements that complement the ‘breath’ rather than causing further exertion to the already fragile bone density.
It is recommended that expert advice be sought and the exercises should be undertaken only under trained supervision. Please do not attempt to “experiment” with Yoga or Tai-Chi on your own, as improper or wrong posture could lead to irreparable damage to the spine. 


If you would like to consult with me privately, please click on 'Consult'.

From Lybrate: If you found this tip useful, please thank the doctor by clicking on the heart icon below. Also, spread good health by sharing this tip with your loved ones over WhatsApp, Facebook and other media.

 Exercises for Sciatica To Keep It Under Check

Sciatica nerve is the longest nerve of our body, which starts from the spinal cord, passes through the lower back and into the lower leg. Sciatica is a symptom of pain in the sciatic nerve which occurs if it is being compressed by any mass, irritated or overgrowth along its course.

Symptoms
Patients with sciatica experience severe pain along their back as well as may suffer from additional symptoms including numbness and weakness, a feeling of tingling and pins and needles on the foot or toes. In severe cases, some people may also suffer from loss of bladder and bowel control.

Causes
One of the most common reasons is the pinching of the nerve due to a slipped disc in the lower back. Other conditions which cause sciatica are trauma to the spine, spondylolisthesis, spinal tumors and lumbar vertebral canal stenosis.

Prevention
One of the easiest ways to prevent sciatica is by protecting your lower spine. You can follow these easy tips that can be really helpful in maintaining your health and remaining pain free.

    Exercising regularly: By exercising regularly, patients can strengthen their back and abdominal muscles and prevent damage to their vertebral column.
    Good posture: By maintaining a good posture while sitting and working in an ergonomically designed chair that properly supports your hips and back and does not compress the back of your thighs and knees while sitting is essential to maintain a healthy back.

Treatment
Homeopathy offers natural medicines that can cure and reduce sciatica pain. One of the biggest advantages that homoeopathy offers for treating sciatica is that it can treat the disease effectively, by rectifying the compression or irritation on the sciatic nerve.

Homeopathy practitioners use Colocynth for treatment caused in right sided sciatica pain. Homeopathic medicine Gnaphlium is used to treat numbness associated with the paint, while Rhus tox is usually helpful in treating all sciatica symptoms and is the most preferred medicine by homeopathic practitioners.

Homeopathy also offers additional benefits as it not only helps in rectifying sciatica pain it also help in strengthening a patient s constitution so that the disease is cured from its roots and there are no further recurrences. Homeopathic medicine is very fast and effective and is totally natural, free from any side effects. It is one of the most widely accepted forms of medicine which causes no side effects and can be taken easily by both men and women. 

7 Homeopathic Remedies for Sciatic Nerve Compression Pain

Sciatica pain arises from the sciatic nerve which is the single largest nerve in our body. It consists of individual nerve roots, which branching out from the lower back of the spine to the back of each leg and combining together forms the sciatic nerve. The origination of the sciatic pain lies in the lower back of the body and radiates down the buttock to the sciatic nerve.

Causes of the sciatica pain

Arthritis: If an individual is diagnosed with arthritis, then he or she can expect a throbbing pain or numbness down till the leg.
Herniated disc: Another cause could be a herniated disc in the lower back of the body.
Spondylosis: Spondylosis in the lower back would also be a reason for the development of the sciatica pain.
PIVD/DISC bulge
Other causes are a spinal injury, diseased degenerative disc, infection on and around the lower back. The pain would worsen, if an individual is in an occupation where he or she has to stand or sit for hours at length. The lifting of heavy things would strain the sciatic nerves as well.

How to identify sciatica pain?
Sciatica pain varies from infrequent to a constant throbbing down the lower back. So initially it is difficult to detect whether it is sciatic pain or not. But when the constant pain in the lower back leads right down till the toes and foot, it is really time for an individual to get in touch with a doctor. The pain can give a burning sensation almost searing making it difficult for the person to stand up or walk properly. Along with the pain, one can feel fatigued. An involvement of the spinal cord is rare in the sciatic pain but is possible.

Treatment for sciatica pain
Sciatica can be treated in both surgical and non-surgical way. Surgical treatment is rare as sciatica tends to respond well with non-surgical treatments. If the pain continues for over a month despite treatment, surgical treatment will be considered. The non-surgical pain treatment would include physical exercises and oral medications along with natural treatment.

Medications: Painkiller medications prescribed by the doctor can be used to reduce sciatica. Medicines like aspirin, non-steroidal or oral steroids can help reduce the pain.
Steroid injection: Epidural steroid injection acts faster as it is injected in the affected area, thus providing relief from the pain quickly.
Exercise: Early morning exercises can be quite helpful.
Percutaneous Endoscopic Discectomy: The surgical treatment of Percutaneous endoscopic disc dissectomy constitutes a large part of interventional pain physicians and it has evolved considerably in terms of surgical technique and instrumentation. Percutaneous endoscopic discectomy is a relatively new technique for removing lumbar disc herniation. It involves using an endoscope to visualize the disc removal. The discectomy is performed through a posterolateral approach using specially developed instruments. The advantage of percutaneous endoscopic discectomy is that the disc is approached posterolaterally through the triangle of Kambin without the need for bone or facet resection thus preserving spinal stability. The procedure is day care and is done under local anaesthesia.

Sciatica Pain - 5 Ways You Can Treat It!

Sciatica is probably one of those things which is vaguely familiar but a person is not fully aware of it. The sciatic nerve is one which is part of the spine and then spreads out over the legs. When this nerve gets pinched, it leads to sciatica, or pain of the sciatic nerve, which is tremendous! But, then, what exactly is a person to do in order to reduce the pain caused on account of sciatica?


The best answer for this is not medication, though it does have its uses, but rather, exercises which help the situation improve and reduce the risk of the person going mad due to the pain! One of the simplest exercises that a person can start with is known quite commonly as the knee to shoulder exercise. All that one needs to do is to lie down on the back and then, raise one knee and pull it across the body, with hands wrapped around it, so that it touches the opposite shoulder. This position of the knee touching the shoulder is to be held for about half a minute. About 3 repetitions need to be done and the same with the other side.


While it is important in the effort to relieve pain due to sciatica, it is equally important not to push oneself beyond natural limits, especially initially as this can cause injury. After all, more pain is the last thing which a person with sciatica is likely to want!


Since it is important to keep in mind the fact that consistency is one of the key secrets to reducing the sciatic pain, it is worth keeping in mind the standing hamstring stretch. What this exercise can boast of is the fact that it is one which can be done nearly anywhere. Also, it is pretty simple, too!


To do the standing hamstring stretch, one leg needs to be kept on an elevated surface which is not as high as the level of the hip. It is important to keep in mind that the leg is to be kept straight. The torso needs to then be bent towards the elevated leg. This process should be done slowly and again, maintained for about half a minute.


The sitting pose is useful to remember, as well. Sitting on the floor, one leg s ankle should rest on the other s knee. Like the standing hamstring stretch, the upper torso is to be bent towards the extended leg. With all these exercises, relief is not far away!


Top Ways To Get Pain Relief From Sciatica

The pain in the lower extremity of the body caused by the irritation of the sciatic nerve (the large nerve running down from the lower back of the body to each one of the legs) is referred to as Sciatica. Sciatica is caused by injury, inflammation or compression of the sciatic nerve and causes pain or numbness spreading to leg, buttocks, and hips. In Ayurveda, Sciatica is known by the name of Gradhrasi. It is believed to be aggravated by the imbalance of Vata Dosha.


Causes -

Sciatica can be caused by strenuous physical activity such as heavy weight lifting, or to exposure to extreme cold. Pressure on buttocks due to sitting or lying continuously for long hours, injury due to a fractured pelvis or trauma to thighs also damages the sciatic nerve.


Symptoms -

Pain in the back and the lower extremity of the body is the primary symptom of Sciatica. Also, there is a burning or tingling sensation in the affected area. It can also become numb. One may even find it difficult to walk. In severe cases, it becomes impossible to bend the knee or move the foot.


Treatment Through Ayurveda -

Through Ayurveda, Sciatica can be treated internally and externally by balancing the energies involved in the doshas:

Internal methods of treatment: Yogaraja Guggulu is the herbal pill consisting of Guggulu resin, twenty-five types of herbs and ghee effectively treats all types of pain associated with the nervous system. Dashamula Arishta, an elixir having sixty-three herbs, jaggery, plums, honey, and water has anti-inflammatory properties which help in toning up the affected nerve.

External methods of treatment: Application of Sarshapadi medicinal oil (made up of camphor, mustard oil, and vegetable turpentine as a base) on the affected area helps in relieving pain.

Panchakarma therapies are very effective in the treatment of this condition. They aim to relieve inflammation and release nerve compressions and spasms for strengthening the entire spine and the surrounding tissue. Generally, treatment through the Panchkarma therapies takes four to five weeks depending upon the severity of the condition. Following are some of the processes involved in treatment through Panchakarma:

Kativasti and Elakizi, Naranga Kizhi, Navarakizhi are very important in the treatment of sciatica.

Sarwang Abhyang is the full body massage with medicated warm oils for lubricating and nurturing the body for the pacification of Vayu.

Swedana refers to steaming the body for detoxification.

Vasti refers to the administration of medicated oils and decoction through anal route for treating the vatic disorder that is Sciatica as per Ayurveda. It pacifies dryness and strengthens intestines and is one of the permanent cures for most of the vatic disorders.

Siravedha is the venous puncture or venesection.

Agnikarma is the Cauterisation or burning the affected part.

Raktamokshan is the process for Blood purification.

Take Away-

Sciatica refers to the pain in the lower body due to an irritated sciatic nerve, caused due to nerve compression or trauma or injury. Through Ayurveda, Sciatica can be treated through internal or external methods as well as through Panchakarma therapies.

Sciatica - Panchakarma Therapy To Heal It!

Don't wait any longer, manage your Sciatica online with a Lybrate doctor today

Consult for Sciatica - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES