Desert Institute for Spine Disorders, PC
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Sciatica

 

What is Sciatica?

 

If you notice a sudden or gradual onset of leg pain that radiates below your knee to your foot or ankle, you have sciatica.  Having isolated back and buttock pain is not consistent with sciatica and patients who have sciatica may have one of many conditions that under most conditions can be corrected with either conservative means or via minimally invasive surgery. Those who are middle age are at increased risk, and are often the result of the natural progressive degenerative process. The most common cause is a protruded herniated disc in your spine causing compression of the nerve that radiates down your leg.

 

Symptoms

 

It is not uncommon that chronic low back pain will preceed the onset of sciatica and may feel like a bad leg cramp or pain that lasts for weeks before it goes away. You may have pain, especially when you sit, sneeze, or cough. You may also experience numbness (pins and needles), burning or weakness, in your leg.

 

 

Causes

 

Herniated Disc: This is a protrusion of the center of the disc that compresses the nerve root which is located directly behind the disc.  This is clearly different from a disc bulge which is a very common MRI finding that is found in 81% of the asymptomatic population.  A herniated disc is therefore a very different objective finding compared to a degenerative related disc bulge, and the two are commonly confused.

 

Two percent of the population will experience at some point a problem with their disc resulting in a herniated disc, but fortunately 80-90% will recover within 6 weeks and will not require surgery.

 

There are a number of emergency situations that are important to mention that may be related to a herniated disc.  A herniated disc can cause enough compression that it results in bowel or bladder issues, loss of function and movement in one or both legs, or numbness in the genital area with a very distinct distribution.  If you experience any of the above problems, then you must see a spine surgeon immediately through the emergency room at a major hospital or at the surgeon’s office.

 

 

 

Diagnosis

 

Your evaluation will require you to provide a very detailed explanation of your symptoms.  How you feel, the distribution of the pain, and how long you noticed the symptoms is the start of the history taking you should expect from your doctor.  This history is the most important part and the list of questions your doctor will ask will be long.  Try to organize you thoughts and history prior to your visit.

 

The purpose of the physical examination is to try and identify other issues related to your condition and provide the surgeon a glimpse of the extent of your problem.  The examination can be uncomfortable but is important in generating a differential of the source of your problem, and is not intended to hurt you.

 

The diagnostic studies will serve to help confirm the diagnosis and clarify any discrepancies between the history and the physical examination. This will include plain xrays and MRI in the majority of cases.  Plain CT scans are of limited use in patients with sciatica.  The exception to this would be the patient who has already had a spinal fusion and is suffering with sciatica.  These patients will need a CT-Myelogram (contrast).

 

 

Treatment

 

The first stage in treating patients with sciatica is conservative treatment.  In fact the vast majority of patients who are suffering with sciatica will have complete relief of their pain with time.  The problem typically will heal itself over 4-8 weeks, and patients will be able to resume their normal activities.

 

Other non-surgical options include, 2-3 days of limited bed rest, physical therapy, stretching exercises, light aerobic exercise, non-steroidal anti-inflammatory medication, neuropathic pain medication, muscle relaxants, and the use of either heat or cold therapy.  All of the above noted conservative treatment is done to help reduce inflammation and pain while you recover naturally.

 

There is a reason for the limited bed rest for this condition.  The spine responds very well to activity.  Maintaining your exercise and activity level will help to reduce inflammation and will accelerate your recovery. Find positions that are comfortable while maintaining an active life style as soon as possible.

 

Injections into your spine with steroids can in most patients provide only temporary improvement in you pain lasting between a few days to a few weeks.  What we find is this conservative treatment will sometimes reduce your pain enough so that you can glean more benefits from therapy and exercise.  It is often difficult to exercise when you are in pain, and this will help by reducing some or all of that pain.

 

Surgical Treatment

 

If you are one of the 10-20% of patients who did not respond favorably to conservative treatment over a period of 2-3 months, then the surgical options will be available to you.

 

If your sciatica is from a herniated disc, then you can expect a 90-98% chance of improving significantly your sciatic pain with a minimally invasive disc removal operation.  This will remove the portion of the disc that is directly compressing the nerve root and only this portion of the disc and any other loose fragments are removed.

 

There are few different types of minimally invasive disc surgery that are available with varying degrees of success. Most if not all fellowship trained spine surgeons have been trained in all of the available techniques.

  • Microscopic Lumbar Discectomy: This procedure is the most commonly used among fellowship trained spinal surgeons, and carries a 98% success rate.  You should anticipate a 1 inch incision and an outpatient surgery.

  • Laser Discectomy or Microendoscopic Discectomy: This technique is still done by only few remaining surgeons, and carries a 90% success rate and an increased risk of nerve injury due to the limited visibility, and the foraminal approach for the camera which can injure a different nerve root. You should anticipate a ½ inch incision and an outpatient surgery.
  • Open Discectomy: Before the advent of newer technology that allowed us to create smaller incisions and a minimally invasive approach to removing a herniated disc, this was the mainstay approach for removing the disc, and is still used today with a 98% success in reducing sciatica.  The incision is much larger with more muscle dissection.  This is still a common approach in the United States, and especially in third world countries.

 

 

Rehabilitation:

 

Most patients enjoy a significant improvement from their leg pain after surgery.  In order to heal properly, patients must avoid any activity that requires prolonged sitting or bending.  This includes driving, excessive sitting, lifting, or bending forward for at least a 3-5 weeks after surgery.  There will be no restrictions on walking and this will be encouraged by your doctor.  Your surgeon may recommend physical therapy and exercises to help strengthen your back.

 

Most patients who are successful in reducing their pain (sciatica) can expect to resume their normal lifestyle and activities of daily living while keeping their pain under control.  The risk of having a recurrent herniated disc is between 1-5% and is usually treatable. 

 

Desert Institute for Spine Disorders

8573 E. Princess Dr.  Suite #221

Scottsdale, AZ 85255

Office (480) 656-4048

Fax (480) 247-6146

www.AZSpineSurgeon.com