What is Sciatica?
Sciatica is the pain that occurs in the large sciatic nerve that runs from our lower back down through the back of the legs. It’s a disease that causes severe and debilitating pain. Sciatica pain that originates in the lower back moves down and travels through our buttocks along the path of the sciatic nerve, behind our legs causing numbness, tingling sensation or weakness.Anatomically speaking, this nerve is the largest single nerve in our body and constitutes of individual nerve roots that starts by spreading out from our spine in the lower back and then assimilate to form the ‘sciatic nerve’. The symptoms of this disease arise, when this large nerve gets compressed or irritated at or near its point of origin.
Causes and Risk factors
Patients suffering from sciatica pain are rarely aged below 20. This disease is commonplace in middle age people who are between the ages of 40-50.While sciatica pain is often loosely used to describe all kinds of leg pains, but researchers estimate that up to 43 percent of the global population gets affected with this disease, at some times in their lives.Although pain from a pinched nerve can be debilitating, but most of the patients suffering from sciatica, find themselves feeling better with medication, within a few weeks or months.
Sciatica is a condition that seldom occurs because of a particular injury, but rather this painful condition develops over time.
The following 6 lower back medical issues are the most common causes of sciatica:
In addition to the above stated 6 most common causes, a number of other conditions can also cause sciatica, which includes:
Sciatica can be treated both surgically and non-surgically. There are a wide range of options that are available for nonsurgical sciatica treatment, such as, ice and heat compression on the affected site, ingesting over-the-counter pain medications and injecting epidural steroid injection for relieving acute pain. Usually all these treatments are prescribed in conjunction with specific exercises. In addition, these common medical treatments, a wide number of alternative treatments have also proved effective for many patients for alleviating this pain. Some of the most accepted forms of alternate care for treating sciatica includes acupuncture therapy, chiropractic manipulation, massage and cognitive behavior therapy.
Sciatica is a neurological condition that mainly arises due to problems in the sciatic nerve. The sciatic nerve is believed to be the largest nerve originating from the spinal nerves L4 to S3. It extends downward from the lower spine into the back of each leg (thighs) right down to the foot. The sciatic nerve acts as a connecting link between the spinal cord and the foot and the leg muscles. People with sciatica often experience a tingling sensation along with a shooting pain radiates downwards from the lower back (mostly the lumbar region) to the back of one of the legs. Some may also experience the sciatic pain down both the legs (rare).
Types of Sciatic Pain:
Sciatica that affects a person can be of two types depending on the severity of the associated symptoms
Symptoms associated with Sciatica:
What triggers sciatica and the associated symptoms?
Proper management and prevention for sciatica are possible. One should be alert and consult a doctor in case they experience the associated symptoms or any discomfort. In case you have a concern or query you can always consult an expert & get answers to your questions!
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.
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
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.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Sciatica pain can be mild to intense. Many with lumbar herniated disc and sciatica often wonder whether or not they require a surgery. Needless to say, it is never an easy decision. But the good news is that micro discectomy surgery has a higher rate of success when it comes to relieving sciatica pain. When compared to many other options, this one is relatively minimally invasive. It doesn’t alter the structure of the spine permanently since it works by removing a small portion of the disc, which has herniated or extruded out of the disc.
When your sciatica pain stems from lumbar disc herniation, a small open surgery with the help of magnification is the prevalently opted surgical approach. On the other hand, a laminectomy is done when the bone or disc pinching the nerve root is required to be removed.
When should you consider undergoing surgery for sciatica?
Typically, neurosurgeons recommend considering surgery for sciatica in a host of situations which include the following:
Thus, choosing to go for a surgery depends on several factors that only your doctor can assess and decide upon.
In case you have a concern or query you can always consult an expert & get answers to your questions!
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
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.
Lower back pain is fast becoming an epidemic not just among elderly, but across all age groups. Primary causes of back pain are quite a few including lumbar hernia, disc degenerative disease (DDD), spondylosis etc., but the symptoms are usually the same excruciating pain in the lower region of the spine, followed by stiffness. Since back pain is caused due to a number of spinal problems, it manifests differently in different patients. The pain may be dull, burning or sharp. It could also be felt at a single point or over a broad area and could be accompanied by muscle spasms or stiffness or even shooting pain in one or both legs.
Back pain can also be differentiated according to time period:
Sometimes symptoms resolve on their own, but in many cases conservative treatment, such as physiotherapy, which often work better than surgery, becomes essential. Alternate therapies like surgery, acupressure, acupuncture as well as yoga and Ayurveda also help.
Physiotherapy - Exercises that work
Since the reason for low back pain is not always same, a patient’s treatment too should be tailored for his specific symptoms and condition. This is what the physiotherapist will do design an exercise plan based on the patient’s specific problem and its cause.
Physiotherapy exercises help support the back and strengthen muscles so that the spine is cushioned properly. This is why physiotherapy is relevant as a treatment for backache. Treatments like traction help in lengthening the spine and relieving compression of nerves that cause sciatica, radiating pain into legs largely due to lumbar herniation. If back pain is extreme, a patient will require physical therapy along with medication, which will help in managing pain and bringing inflammation down. But in the long term, being physically active, going for walks, sitting properly and maintaining a good posture will help the most. If you wish to discuss about any specific problem, you can consult a physiotherapist.
What is Sciatica?
Causes and Risk factors