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ciatica is a painful condition caused by a trapped nerve in the spine. The pain typcially starts from the lower back and refers down into the leg. This may be associated with pins and needles, numbness or weakness. Treatment can include physiotherapy, medications, spinal injections, laser spine surgery, keyhole spine surgery or sometimes spinal ozone therapy.

Sciatica can be one of the most painful conditions to affect a persons health.

The sciatic nerve is the longest and thickest of the anatomy and is the extension of the fourth, fifth, fifth, first, second and third sacral roots, whose entanglement forms the sacral plexus. Sciatica affects many people. The most important symptoms are pain radiating to the leg and functional problems. Patients are usually treated in primary care but a small proportion are referred to specialists when the problem does not settle and eventually, they are operated.

Diagnosis

An MRI scan is the most definitive method of diagnosing a disc herniation, spinal stenosis or other cause of sciatica.

Approximately 90% of cases are caused by a herniated disc with root compression but stenosis and, less frequently, tumors are also possible causes.

Low back pain is strongly related to disc degeneration, but disc degeneration is also associated with referred pain or “sciatica” and herniated or disc prolapse, which has adverse effects on other vertebral structures such as muscles and ligaments.

Sciatica is diagnosed mainly by assessing symptoms and physical examination. In general, patients report a pain radiating to the leg. In the presentation, doctors can try to identify the distribution of pain and if it radiates below the knee.

Sciatica in Pregnancy

Many factors are responsible for the onset of sciatica in pregnancy, such as weight gain and postural changes throughout this stage.

Pregnancy itself does not cause sciatica, but rather it is a condition that appears in patients who previously had a back injury.

Treatment Plan

1. The patient needs to take some rest, but it must not last more than 2 days.
2. After a couple of days, it is important to leave the bed and perform a light but progressive physical activity, as you are having less pain.
3. The application of local heat many times a day is helpful. Also, a massage when muscles in that area are contracted is especially efficient.
4. Take analgesics to relieve pain, such as nonsteroidal anti-inflammatory drugs.
5. The regular practice of rehabilitation exercises and sports help in the treatment.
6. Sciatic stretches help to keep the nerve moving and should be performed gently.

Prognosis

In general, the clinical course of acute sciatica is favorable and pain and functional impotence resolve within a few weeks. The prognosis is good in most patients, but at the same time, there is a significant proportion (30%) that continues with pain for 1 year or more.

What is the effectiveness of conservative treatments?

The main objective of conservative treatment is to calm the pain, either by means of analgesics or by reducing the pressure on the nerve root. Conservative treatments do not completely improve the natural course of sciatica in most patients or completely reduce their symptoms.

A small difference was found between the effect of bed rest and that of the continuation of activity on pain and functional status. As a result of this finding, bed rest is less recommended-which was, for a long time, the treatment of sciatica.

What is the importance of surgery in sciatica?

The objective of the surgical intervention is to eliminate the herniated disc and eventually the partial removal of the disc or stenosis of the foramen, in order to eliminate the cause of sciatica.

Laser Disc Surgery is a new technique which can be used to treat lumbar disc prolapse without the need for open surgery. A laser probe is used to shrink the disc prolapse.

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inimally invasive spinal surgery is a very interesting new option that can help relieve chronic back and/or leg pain. Keyhole surgery for sciatica, back pain, lumbar fusion, disc replacement is now available. Our top spinal specialists offer the best solutions for treatment. Harley Street Hospital, London.

Recent advances in Instrument technology allows Spinal Surgery to be performed through Keyhole incisions:

Minimally invasive spinal surgery is a very interesting new option that can help relieve chronic back and/or leg pain. Your surgeon is the most qualified professional to advise you, clarify your doubts and present reasonable expectations about your therapy. The decision to operate requires your greatest consideration. Always write down all the questions and decide with your surgeon if minimally invasive spinal surgery is the right option for you.

What is different about minimally invasive surgery compared to traditional surgery?

The traditional spine surgery usually requires long incisions in the back. The muscles are cut and separated from the spine to give access to the area.

Minimally invasive spinal surgery is done through small incisions in the back. Surgeons use special instruments, such as intraoperative radiographs, microscopes, and tubular retractors. Both types of surgery are intended to relieve back or leg pain. However, minimally invasive spinal surgery attempts to cut as little muscle as possible.

Minimally invasive surgery has many advantages over traditional spinal surgery:

• Smaller incisions.
• Less blood loss during the surgery.
• Smaller scars.
• Shorter hospitalization.
• Less pain and medication for pain during recovery.
• Faster return to work and daily activities.

What are the benefits and risks?

Each patient is unique, so there are not two that react in exactly the same way. Minimally invasive surgery is often used for many types of procedures, such as removal of the gallbladder and appendix, as well as a total hip replacement. Recently it has been applied to spine surgery, including spinal decompression and spinal fusion.

Minimally invasive spinal surgery carries the same risks as any general surgery. Complications such as infection, pain and nerve damage may occur. Talk to the surgeon to make sure you understand the risks and benefits of the minimally invasive spine treatment that has been recommended for you.

If there are problems or access to the spinal area is not clear during your minimally invasive surgery, the surgeon may decide that it is necessary to opt for a traditional procedure.

During your recovery, you will see your surgeon on follow-up visits and begin a program of physiotherapy and special exercises. The time of recovery will depend on your body’s ability to heal and varies among patients.

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ow back pain can affect us all. Its importance is directly related to its frequency and intensity. Isolated episodes of pain are usually associated with various causes: after unusual physical exertion, for example. If the pain is frequent and its intensity increases, the problem is more serious.

Being overweight, the absence of regulated physical activity and the lack of knowledge about postural hygiene are risk factors for mild low back pain to become a serious health problem.

It should be noted that low back pain can be due to several physical factors: the state of the musculature, the integrity of the vertebrae and fundamentally, the quality of the intervertebral disc.

About the spinal discs
Discs are basically structures made up of liquid. They have two well-defined components: the external part (fibrous ring) and contained by this is the nucleus pulposus, the extrusion of which forms a herniated disc. The discs are pads located between the vertebrae. The discs, the musculature, the ligaments and a part of the vertebrae called the articular processes are key structures to explain the flexibility and movement of our spine in general.

The cause of low back pain in regards to the intervertebral disc stems from dehydration and loss of the nucleus pulposus.

Degenerative disc disease
When obvious dehydration of the disc is diagnosed we go on to name the disease as degenerative disc disease. This pathology can present various degrees of evolution and cause low back pain.

When the patient presents with progressive low back pain, he usually has an inability to carry on a normal life. It is one of the most frequent causes of sick leave, poor physical performance and dependence on pain relievers.

The appropriate diagnosis of this disease can lead us to indicate conservative treatments and potentially surgical treatments that can range from local treatments (infiltrations, facet rhizolysis, nucleoplasties) to surgical treatments, either by immobilizing the affected disc by applying screws and bars, until the total replacement of the disc by a mobile prosthesis.

Lumbar disc arthroplasty consists of removing the diseased disc and replacing it with a mechanical one, without altering the mobility of the spine and preserving the normality of the other discs.