Sciatica

WHAT IS SCIATICA ?

Sciatica is a symptom caused by lumbar disc herniation and the pain generally affects the back, hip and leg. In such a case, the disc between two lumber vertebra compresses over existing nerve roots and causes radicular pain in one or both legs. It results in the patient experiencing tingling, numbness and stretching kind of pain in either one or both the legs. The pain can radiate up to toe, fingers and ankle however sometimes pain may only radiate up to the thigh and above knee

WHAT ARE SYMPTOMS OF SCIATICA ?

• Tingling and numbness in one or both legs
• Ant walking sensation
• Radicular pain in leg
• Pain increase by walking and standing
• Partially or completely relieved by rest or lying down position
• Pain may provoke by coughing, sneezing or any kind of straining
• WHAT ARE CAUSES OF SCIATICA?
• Sciatica is mainly caused by the irritation of sciatic nerve or its fibers
• Lumbar disc herniation is the main cause of Sciatica
• Degenerative vertebra can causes Sciatica
• Muscle inflammation, injury or tumor can cause Sciatica

HOW SCIATICA IS DIAGNOSED ?

History and physical examination can give clues to suspect sciatica. X ray and MRI of lumbar spine can help to diagnose sciatica as well as help to find out causes of it. MRI also guides a treatment plan.

WHAT ARE TREATMENT OPTIONS FOR SCIATICA ?

CONSERVATIVE

For acute and less severe pain, rest and medicine can help few of patients. Avoiding forward bending, lifting weight, avoiding sitting on floor will help. If patient feels improvement in pain we can continue a conservative approach with medicine and exercise for four weeks.

INTERVENTIONS

As science advances treatment of sciatica is becoming less and less invasive. Now a day’s for sciatica minimally invasive treatments are widely available. Sciatica treatment in India is keeping pace with world. All advance and minimally back pain treatment also available in India.

If exercise and medicine are not working than your doctor might suggest you some intervetions. Pain Management treats such diseases with techniques called intervention. Intervention is a small injection technique which helps to get rid of root problem of Sciatica without surgery. Your doctor will see all reports and then suggest you best treatment options for you.

TRANSFORAMINAL BLOCK

Mild bulge (Slipped) Disc can cause a swelling on the existing nerve roots. Injecting a drug in to a foramen will reduce that swelling inside and help the patient by dissipating the pain.

Transforaminal Block is given under local anesthesia. It is given under live X-ray (C arm) guidance. Here we numb a part of the back and insert a thin needle inside. The needle is guided with the help of a Live X-ray Machine.

This is a 15 minutes procedure and patient can walk away after 2 hours.

PERCUTANEOUS DISC DECOMPRESSION / NUCLEOPLASTY

In this procedure we remove a part of the herniated disc through a needle. No incision or surgery is required for this procedure. We have latest equipments to do these procedures.

This procedure is recommended in Sciatica patients who have a significant disc herniation which is pressing on nerve roots and not responding to conservative treatment.

 We numb the skin of the back. Under live X- ray (under IITV) guidance, we insert a needle like instrument called Disc dekompressor or nucleoplasty in the back. This instrument goes in between vertebra in to a disc. Once we confirm an instrument position with a live X-ray (IITV) machine, we turn on the machine and use latest techniques to remove a significant part of the disc which is called Nucleus Pulposus. Usually we do this procedure for three minutes. Once significant amount of material is removed we remove the instrument and put a small dressing at the spot from where needle was inserted in the back.

ENDOSCOPIC DISC REMOVAL

For an endoscopic disc removal we remove a bulged disc through an instrument called endoscope. After numbing a skin and underlying muscles we insert endoscope inside a slipped disc. We remove a bulged disc under direct vision. It is an excellent procedure and we can remove a significant amount of disc material with this procedure. Patient can go home on same or next day. After seeing at all reports and MRI scan doctors can decide which procedure is good for patient.

WHAT TO EXPECT AFTER THE PROCEDURE ?

• Mild aching back, which will be relieved with medicine
• Improvement in pain will start after two to three days
• It is recommended that patients apply ice on the back for three to four days
• Patient must take rest for 1 to 2 days although no complete bed rest is required

ADVANTAGES OF THIS PROCEDURE

1. Get rid of Sciatica problem without surgery
2. Remove a part of disc
3. Procedure done under local anesthesia so we can avoid general anesthesia
4. No bed rest needed
5. Less post-operative pain
6. Short recovery period
7. Get results equal to surgery
8. Provide a disc sample for biopsy if required
9. Intense rehabilitation not required
10. Avoids surgery and consequences of surgery
11. No scarring after procedure
12. Cost effective due to reduced hospital stay
13. Can be done on elderly patients also

SURGERY

LAMINECTOMY

Sometimes due to severe Stenosis or loss of sensation in the leg / legs, the patient is required to go for an open surgery called Laminectomy. Laminectomy should be done under general anesthesia. Laminectomy is a surgery done to remove excessive pressure on the spinal cord and nerve roots. Laminectomy removes a portion of thin part of vertebra called lamina which forms a protective arch of vertebra. Laminectomy also removes a thick part of tissue around spinal cord on selected vertebra.