A Glimpse Of Microdiscectomy
A microdiscectomy is a very effective surgical procedure that removes part of the bulging or herniated intervertebral disc within the lower spine and leaves the healthy portion intact. Muscle tissues are removed from the lamina to make a window in the spinal canal. With the discs portion now not causing blockage, the herniated tissue is removed. With a herniated disc, the disc can press on the spinal nerves causing numbness and pain in the buttocks or the leg.
A microdiscectomy significantly reduces sciatic pain but some aching may be felt along the sciatic nerve afterwards since, not everyone experiences a complete relief after the procedure. At times the nerve has what may be termed as a memory of the pain and it remains quite irritable. A typical microdiscectomy recovery takes place in about six weeks Post Op and the patient will experience an increased comfort level as time goes by.
Other possible causes of sciatica after a microdiscectomy may be
- A wrong diagnosis.
- A secondary disc herniation.
- Dual problems that bring about the pain, where two lesions cause the pain and the piriformis muscle is not rehabilitated.
- Nerve damage during the surgical procedure.
- A scar tissue.
Randomised Controlled Trials Not Yet Included In Systematic Reviews
Two additional randomised controlled trials have been published comparing disc surgery with conservative treatment. One trial compared microdiscectomy with conservative treatment in patients who had had sciatica for six to 12 weeks. Overall, no significant differences were found for leg pain, back pain, and subjective disability over two years of follow-up. Leg pain, however, seemed to initially improve more rapidly in patients in the discectomy group. The large spine patient outcomes research trial and related observational cohort study was carried out in the United States. Patients with sciatica for at least six weeks and confirmed disc herniation were invited to participate in either a randomised trial or an observational cohort study. Patients in the trial were randomised to disc surgery or to conservative care. Patients in the cohort study received disc surgery or conservative care based on their preference. In the randomised trial both treatment groups improved substantially over two years for all primary and secondary outcome measures. Small differences were found in favour of the surgery group, but these were not statistically significant for the primary outcome measures. Only 50% of the patients randomised to surgery received surgery within three months of inclusion compared with 30% randomised to conservative care. After two years of follow-up 45% of patients in the conservative care group underwent surgery compared with 60% in the surgery group.
When Sciatica Symptoms Become Dangerous
As I mentioned, most sciatic nerve problems are temporary and heal naturally or with conservative intervention, such as pain medication, physical therapy, gentle home exercise, and time. In extreme cases, such as spinal stenosis or osteoporosis-related vertebrae collapse, surgical intervention may be necessary to assure theres enough room to avoid nerve compression.
However, there are two classes of sciatic nerve condition that may have serious and lasting impact on your health. Each of these should, if suspected, be treated as a medical emergency.
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Causes And Risk Factors Of Sciatica
Sciatica originates from an issue with the sciatic nerve, a large nerve that provides innervation and physical sensations to various parts of the skin and muscles of the legs and feet, according to StatPearls.
The sciatic nerve is made up of five nerve roots two from the lumbar spine and three from the sacrum . These nerve fibers converge to form a left and right sciatic nerve, which run down the two sides of the body to the back of the knees. The sciatic nerve then branches into other nerves that continue down into the legs, feet, and toes.
Sciatic pain is primarily caused by an injury to the nerve in your lower back region, such as from irritation, inflammation, pinching, or compression of the nerve.
The most common cause of sciatica is a herniated disc in your spine that puts pressure on the sciatic nerve roots. Some research suggests up to 90 percent of sciatica cases stem from herniated discs.
Other spinal issues may also cause sciatica, including:
- Spondylolisthesis, in which a vertebra slips out of alignment
- Foraminal stenosis or spinal stenosis, conditions marked by a narrowing of the spinal canal
- Synovial cysts in the spine
- Tumors of the spinal column or the nerves
- Degenerative disc disease
- Bone spurs from osteoarthritis
- Cysts or inflammation of the arachnoid, one of the membranes that protect the nerves of the spinal cord
Pain Relief And Treatment
The primary goal of initial treatment is the relief of pain. Treatment and relief options for sciatica include:
Moderate activityBed rest had traditionally been recommended in the treatment of sciatica but this is no longer the case. Research has indicated that bed rest does not tend to speed recovery and may in fact hinder it. It is now recommended that heavy physical activity should be avoided, but moderate activity should be maintained. It is thought that maintaining activity assists with overall recovery by helping to reduce inflammation.MedicationsPain relieving medications such as paracetamol and ipuprofen are commonly used to treat sciatic pain. In cases where muscle spasms are thought to be the cause, muscle relaxant medications may be recommended. When pain is severe the use of opioids may be necessary. Other medications that may be used are low-dose anti-depressants to reduce nerve stimulation, and cortisone injections near the spine to reduce pain and inflammation.
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Secret #: Stretching Programs/yoga
If youre wondering how to get your sciatic nerve to stop hurting, yoga is a great option.
But we want to warn you not to do anything that makes your pain worse, even stretching or yoga.
Yoga is perhaps one of the best ways to relieve the pain of sciatica and prevent its reoccurrence as well, depending on the root cause.
Sciatica is a pain in the butt, literally. What better way to ease the pain than to work it out? Yoga will stretch out muscles that are tight and relieve pressure on the sciatic nerve. Some of the best yoga poses for sciatica are:
- Pigeon on a Chair – This is a great stretch for those who cannot lie flat on the floor without pain. Sit in a comfortable chair. Place your right ankle on top of your left knee and try to move the right knee towards the floor. You can apply very light pressure to the right knee with your hand for a deeper stretch. Hold and repeat with the opposite leg.
- Pigeon Pose – Place a folded towel under your behind and thigh on the right side as you cross the right leg in front of you. Place the left leg stretched out directly behind you. If you can, bend down at the waist over your right leg. If you cant, simply stay in the pigeon pose and feel the stretch. Change sides.
- Cobra – If you can lie on your stomach on the floor without pain, the cobra pose is a good choice. Lie with your palms on the floor under your shoulders, feet together, and pointed behind you. Push your torso up off the ground but leave your hips on the floor.
Surprising Ways You May Trigger Your Sciatica
High Heels and Uncomfortable Shoes
Fans of fancy footwear: if you have sciatica and just cannot seem to shake the pain, your high heels may be causing your discomfort. High heels change your distribution of weight, putting pressure on the front of your foot and causing you to push your hips forward.
When you walk or stand too long with your pelvis pushed forward like this, it puts stress on your hamstrings, stretching them. Since the sciatic nerve is located by the hamstrings, this constant stretching and pressure can do a lot of damage to your sciatic nerve.
Uncomfortable and un-cushioned shoes can also be hard on your feet and your hamstrings. At minimum, try to wear shoes with support built-in, avoiding heels and non-supportive shoes like flip-flops. There are also shoe inserts you can purchase that are designed specifically for people with sciatica.
Carrying Items in Your Back Pockets
If you find yourself always carrying your phone, wallet, or other bulky and heavy items in your back pockets, you could be unknowingly triggering your sciatica. Although this is not an officially recognized cause of sciatica, many people who suffer from this condition have coined their own terms such as back-pocket sciatica and cell phone sciatica.
When you sit down with items in your back pocket, they can put unnecessary pressure on your piriformis muscle, which is located right by your sciatic nerve. Imagine you have a full wallet in one pocket:
Sitting Too Much
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Enhancing Healthcare Team Outcomes
The key to sciatica is patient education. There are many causes of sciatica, and the disorder is best managed with an interprofessional team of healthcare professionals that includes clinicians, mid-level practitioners, orthopedic surgeons, osteopaths and chiropractors, physical therapists, neurologists, rehabilitation nurses, and a pain specialist. Unless there is an acute compression of the spinal nerves, most sciatica cases are best managed conservatively. Patients should be encouraged by the clinician and nurse to lose weight, stop smoking and enroll in a physical therapy program. Bed rest should be limited. For some etiologies, manipulation/manual therapy may be an option. The pharmacist should caution the patient against the use of prescription-strength medications to avoid dependence and other adverse effects and if opioids are used, they should assist the team in making sure the course is very short and not refilled. Surgery should only be undertaken when conservative methods have failed, but the patient must be educated on the risks of surgery and the potential complications. Finally, even after surgery, participation in regular exercise is essential.
Are There Home Remedies And Self
Keys to the management of acute sciatica include relief of pain and relaxing associated muscle spasms. Home remedies include heat and cold pack topical administration, over-the-counter pain medications such as acetaminophen , non-steroidal anti-inflammatory drugs like naproxen , ibuprofen , and aspirin, and physical therapy that incorporates gradual exercises and stretching. Exercises and stretching can sometimes best be guided by physical therapists.
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Are Restless Leg Syndrome Multiple Sclerosis Carpal Tunnel Syndrome Plantar Fasciitis Shingles Or Bursitis Related To Sciatica
While all these conditions affect either the spinal cord, nerves, muscles, ligaments or joints and all can cause pain, none are directly related to sciatica. The main causes of these conditions are different. Sciatica only involves the sciatic nerve. That being said, the most similar condition would be carpal tunnel syndrome, which also involves a compression of a nerve.
A final word about sciatica. . . .
Most cases of sciatica do not require surgery. Time and self-care treatment are usually all thats needed. However, if simple self-care treatments do not relieve your pain, see your healthcare provider. Your healthcare provider can confirm the cause of your pain, suggest other treatment options and/or refer you to other spine health specialists if needed.
Last reviewed by a Cleveland Clinic medical professional on 03/25/2020.
Do The Benefits Outweigh The Risks
Like most surgeries that require general anesthesia, sciatica surgery comes with the risk of blood clots and heart attack. Infection is also a risk with most surgeries. And since this particular operation involves tissues around a nerve, nerve injury is a possibility.
In addition to the general surgery risks, there may be risk factors specific to your background, lifestyle or state of health. Doctors call them comorbidities. They may increase your risk during the surgery or affect how successful the surgery is in relieving your sciatica pain. Studies have shown that factors such as smoking, high blood pressure, diabetes and duration of the sciatica pain before surgery may affect the outcome of the procedure.
If you are seriously considering sciatica surgery, it’s important to partner with a surgeon who would look beyond your physical symptoms and help assess many other factors that may influence your decision.
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How Is Sciatica Affecting Your Quality Of Life
Sciatica pain may extend all the way from the lower back, through the back of your thigh, to your foot. The pain can come and go, sometimes lingering for days and even weeks. This may cause anything from mild discomfort to making the simplest tasks intolerable. Sitting could be painful with sciatica and driving even more so. Not to mention playing sports and being active.
As you contemplate surgery for sciatica, consider how much the pain affects your quality of life. If your work, hobbies, social life or relationships suffer from your being in constant pain, it may be time to think about surgery.
Although sciatica starts as nerve inflammation, it may eventually progress to nerve damage. If the sciatic nerve is damaged, it could result in numbness, tingling and, in more severe cases, weakness in the knees or legs. The longer it is left untreated, the longer it will take for numbness and weakness to go away, and they may become permanent.
What Is The Outlook For Patients With Sciatica Is It Possible To Prevent Sciatica
Depending on the precise cause of the sciatica and the duration of symptoms, the outlook for recovery from sciatica ranges from excellent to having long-term chronic symptoms.
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What Does Sciatica Pain Feel Like
People describe sciatica pain in different ways, depending on its cause. Some people describe the pain as sharp, shooting, or jolts of pain. Others describe this pain as burning, “electric or stabbing.
The pain may be constant or may come and go. Also, the pain is usually more severe in your leg compared to your lower back. The pain may feel worse if you sit or stand for long periods of time, when you stand up and when your twist your upper body. A forced and sudden body movement, like a cough or sneeze, can also make the pain worse.
What Is The Role Of Surgery In Sciatica
Surgical intervention for sciatica focuses on removal of disc herniation and eventually part of the disc or on foraminal stenosis, with the purpose of eliminating the suspected cause of the sciatica. Treatment is aimed at easing the leg pain and corresponding symptoms and not at reducing the back pain. Consensus is that a cauda equina syndrome is an absolute indication for immediate surgery. Elective surgery is the choice for unilateral sciatica. Until recently only one relatively old randomised trial was available that compared surgical intervention with conservative treatment for patients with sciatica. This study showed that surgical intervention had better results after one year, whereas after four and 10 years of follow-up no significant differences were found.
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Serious Medical Conditions That May Cause Sciatica
Conditions with sciatica-like signs and symptoms that require prompt medical or surgical treatment include:
- Spinal cord compression or infection. Compression of the lumbar spinal cord or the cauda equina can cause leg pain and back pain. Spinal cord abscesses, facet joint cysts, or infections can also cause back and leg pain, especially with movement.
Read more aboutCauda Equina Syndrome
- Tumors. Tumors of the lumbar epidural sheath , bone, soft-tissues, sciatic nerve sheath, or the prostate gland may cause back pain and leg pain. Metastatic tumors may also cause symptoms mimicking those of spinal stenosis.
- Blood vessel problems. Blood vessel aneurysms, compartment syndrome, and blood vessel infections may cause leg and back pain similar to sciatica. These conditions may lead to loss of blood supply to the affected leg causing severe symptoms.
- Kidney problems. Kidney pain due to cysts, stones, or infections can radiate to the back and the legs.
Any type of nerve compression warrants prompt medical attention. If progressive leg weakness or numbness is present, the nerve may be damaged, potentially leading to loss of leg function. If the nerve is compressed and the pain and symptoms are severe, surgery may be required.
When Is Surgery An Option For Sciatica
Only a very small amount of people go on to have sciatica surgery. When all other treatment options fail, your doctor may suggest surgery.
Common options include microdiscectomy and laminectomy. These are usually minimally invasive and only require a short stay in hospital.
If you are suffering from sciatica pain and would like to see a consultant spinal surgeon, go to Mr Jonathan Bulls Top Doctors profile and check his availability.
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Epidural Steroid Injections Under X
Corticosteroids reduce inflammation and pain. If you need this level of relief, Dr. Shah injects the steroid directly into your spine near the sciatic nerve. Although not safe for long-term use, steroid injections are ideal for short-term pain relief that allows you to continue healing through physical therapy.
Sciatica Causes And Risk Factors
Sciatica results from irritation of the root of your lower lumbar and lumbosacral spine.
Additional common causes of sciatica include:
- Lumbar spinal stenosis
- Degenerative disk disease
- Muscle spasm in the back or buttocks
Other things that may make you more likely to have sciatica include:
- Your job, especially if it involves driving for long periods of time, twisting your back, or carrying heavy things
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