"Sciatica” refers to the pain that originates in the lower back and radiates down the leg which corresponds to the sciatic nerve pathway in the body. It refers to the symptom of pain rather than a specific condition, illness, or disease. Sciatica pain is often described as sharp, shooting, stabbing, burning or electric type pain. There are several medical conditions that give rise to sciatica pain, which include: herniated or slipped disc, spinal stenosis, spondylolisthesis and other rare causes include- pyriformis syndrome (spasm of pyriformis muscle), trauma, tumour and infection in the spine.
A herniated or slipped disc is the most common cause of sciatica, which accounts for more than 90% of cases. The disc is the cushioning pads between two vertebrae in the spine. Each disc is made up of inner gel-like material (Nucleus pulposus) and an outer thick fibrous ring (Annulus). When the inner nucleus bulges out (herniates) through a weakness in its outer wall and presses on one of the sciatic nerve roots, resulting in sciatica pain. Also, recent studies have established that the cause of pain is not only mechanical compression but associated inflammation(swelling) of nerves by the disc material.
Clinical presentation
Sciatica pain due to disc herniation usually aggravates on sitting, bending forward, coughing, sneezing, contrarily walking is relatively better. Pain may be associated with numbness or weakness in your lower back, buttock, leg, or feet. Sciatica usually affects only one leg at a time. However, it’s possible that pain occurs in both legs. It’s simply a matter of where the nerve is being pinched along the spinal column. Rarely disc herniation can lead to loss of bowel and bladder control (due to cauda equina compression).
Clinical Diagnosis
Clinical evaluation includes evaluation of the site of back and leg pain, neurological examination, and special clinical test for sciatica which includes- Straight leg raise test, also called Lasègue's sign. With the patient lying down on their back on an examination table or exam floor, the examiner lifts the patient's leg while the knee is straight. A positive straight leg test reproduces radiating leg pain.
Investigations
Depending on examination, imaging and other tests might be required, which includes:
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Spinal X-rays
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Magnetic resonance imaging (MRI): diagnosis of choice for disc-related pathology
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Computed tomography (CT) scans
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Nerve conduction velocity studies/electromyography to examine how well electrical impulses travel through the sciatic nerve and the response of muscles.
Management
A majority of patients with disc herniation-related sciatica pain show symptomatic improvement with non-surgical treatment and return to work within six weeks.
Treatment options include:
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Non-Surgical
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Spinal injection
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Surgical
Non-surgical options include:
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Rest for a short period, however, absolute bed rest is not advisable, in fact, it is recommended that people continue with normal activity to the best of their abilities.
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Applying ice and/or hot packs
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Pain medicines: non-steroidal anti-inflammatory drugs (NSAIDs), includes ibuprofen, Aceclofenac or naproxen, etc
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Other medications- Gabapentin and Pregabalin have shown effectiveness in improving nerve-related leg pain.
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Performing gentle stretches and normal walk
Spinal Epidural Injection
An injection of a corticosteroid with local anesthesia directly into the spine around the nerves have shown to reduce the pain and swelling around the affected nerve roots. Many studies have shown that pain relief following injection can last for more than one year in the majority of patients and hence surgery can be avoided.
Surgical Management
Surgery is required when pain is severe and unrelenting and interferes in standing or working or when pain is associated with progressive weakness of leg(s) or associated with loss of bladder or bowel control. Only 8-10% of all patients with disc herniation may eventually need surgical intervention for pain relief.
Surgical options include:
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Discectomy: Removal of the disc fragment
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Open discectomy vs Microscopic vs Endoscopic Discectomy
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Discectomy and Instrumented fusion: when associated with bony instability.
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Disc removal and followed by inserting screws and rods to hold the spine steady
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How Safe is Spine Surgery for Slip disc?
Surgery for disc removal is one of the most commonly performed surgeries of the spine. In the 21st century, with better technology and better-trained spine surgeons, the success rate of spine surgery has improved considerably with a significantly reduced complication rate. The myth of every patient becoming paralyzed or permanently disabled after spine surgery does not hold true in today’s world. In fact, patients are able to walk independently from the next day of the surgery.
The primary goal of herniated disc treatment is to help relieve pain and other symptoms resulting from the herniated disc. The conservative herniation treatment includes pain medication which relieves symptoms in a few days or weeks.
Concern the best doctor for herniated disc, the doctor might suggest physical therapy to ease the pain. There is the best spine specialist in Delhi who is experienced in removing a protruding portion of the disk.
How to prevent Disc herniation?
The exact cause of the disc herniation is still unknown. Therefore it is not possible to prevent it from occurring in a true sense, however, common back pain can be prevented by taking the following steps:
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Maintain good posture while sitting, standing, lifting objects.
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Avoid smoking: Nicotine reduces the blood supply to bones. It weakens the spine and the vertebral disks, which puts more stress on the spine and discs and causes back and spine problems.
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Eat healthily and exercise regularly: Exercise includes: aerobic-based exercise-Walk/jogging, Zumba, pilates for 1 hour daily for core muscle strengthening, and Yoga (Surya namaskar) for flexibility of the spine are the ideal exercises for back pain prevention. Visit Manipal, the best spine surgery hospital in Delhi to know more about the treatment alternatives.
Consultant- Spine Surgeon
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