Sciatica.
What is sciatica?
The term describes the symptom of leg pain and possibly tingling, numbness or weakness that originates in the lower back, travels through the buttock and down the large sciatic nerve in the back of the leg.
The vast majority of people who experience acute sciatica get better with time (usually a few weeks or months) and find relief from pain using standard conservative treatment ie. Anti-inflammatory drugs and rest.
For others, however, the sciatic nerve pain continues and can be severe and debilitating, continuing for month or years constantly, or in repetative episodes each lasting weeks or months.
Sciatica occurs most frequently in people between 30 and 50 years of age. Often a particular event or injury does not cause sciatica, but rather the sciatic pain tends to develop over time as a result of general wear and tear of the structures of the lower spine.
Sciatica can be characterized by the following symptoms:
- Pain on one side of the buttock or in one leg that is worse when sitting
- Burning or tingling down the leg
- Weakness, numbness or difficulty moving the leg or foot
- A constant pain on one side of the buttock.
- A sharp pain that may make it difficult to stand up or to walk
Remember that sciatica is not a medical diagnosis; rather it is a symptom of an underlying problem in the lower back.
This is an important distinction because it is the underlying diagnosis (vs. the symptoms of sciatica) that often needs to be treated in order to relieve sciatic nerve pain.
As mentioned the Sciatica may occur as repeated episodes, as a constant over the years and may be accompanied by lower back pain. Severe pain can be felt often in one buttock and this passes down the leg often reaching the foot. The person may experience numbness in the leg or toes.
Herniated Disc.
A herniated disc occurs when the soft inner core of the disc leaks out, or bulges, through the fibrous outer core of the disc and compresses the nerve as it exits the spine.
A sudden twisting motion or a lifting, bending injury can lead to a disc herniation and sciatica. However, most discs weaken over time due to repetitive stress and the final result you can have a disc bulge.
A herniated disc is sometimes referred to as a , ruptured disk, bulging disc, protruding disc.The back pain and sciatica are the common symptoms which may become chronic as the disc fails to retract and reabsorb.
Spinal stenosis.
This progressive disease commonly causes sciatica, leg pain and weakness (wobbly) of the legs due to a narrowing of the spinal canal and compression of the nerves in the spine.
Spinal stenosis is relatively common in adults over age 60. Spinal stenosis is related to a natural aging process of the spine, and typically results from a combination of one or more problems.
The facet joints can become arthritic causing bony spurs and overgrowths of bone which reduce the space through which the nerves exit the spine. You may have a naturally narrow spinal canal space coupled with arthritic joints which can cause a stenosis.
Spinal stenosis causes progressive back and leg pain, this along with increasing weakness of the legs. The stenosis causes ever decreasing mobility, walking distances achieved become shorter. The need to stop or sit down to rest the legs becomes more frequent. Classically, the person may become hunched over and use a stick to aid walking as the pain and weakness progresses.
Degenerative Spondylolisthesis.This debilitating disease causes back pain because neighbouring vertebra can become unstable and begin to "slip" out of line.
The normal spinal structures holding the vertebrae in its place fail with age and aging diseases, allowing micro movements which pinch the spinal cord.
This causes an intense pain which is often a sudden onset of severe sciatica down the leg.
With spondylolisthesis, back pain may start suddenly with a certain flexion movement.
You may feel a jolt or a slip in the back accompanied with severe shooting pain down the leg and muscle spasm in the back.
Degenerative disc disease.
Disc degeneration is part of the natural aging process that occurs with over a lifetime of activity.
The discs take the wear and tear of activities and may start to fail and causing chronic symptoms including sciatica. The disc loses volume as it loses water content and dehydrates with age.
It may lose its natural shape and sponginess and becomes stiffer and less absorbent to jolts. There may be an old hernia injury of the disc which causes some chronic pain and sciatica type symptoms
For some people one or more degenerated discs in the lower back can irritate or pinch a nerve and cause sciatica.
Treatment of your pain.
The Specialist will see you in clinic to examine you and to take a history of your pain. He may order some tests including X-Ray and /or MRI scan. He can then review all your results and discuss the cause of your pain. Once you have a diagnosis you will be given recommendations for your future treatment. They may or may not include:
: as prescribed by your doctor.
normally non steroidal analgesics.
:
Special infiltrations and injections may be given in the operating theatre under x-ray guidance.
This allows the specialist to place small amounts of local anaesthetic and anti-inflammatory medicines right into the origin of your pain. The anti-inflammatory drug will act to reduce inflammation and your pain over a period of time.
This procedure may be diagnostic, allowing the specialist to confirm the point where your pain originates, or it may be a conservative treatment (non operative) for your pain. These injections may be repeated.
This is the surgical removal of the ruptured disc that is causing your pain and symptoms. This procedure involves a general anaesthetic and a short stay in hospital.
This operation is to halt the progression of Spinal Stenosis, which would eventually leave the patient wheelchair bound.
The surgery aims to improve the pain, symptoms and function of the patient’s legs.
The specialist opens up the narrowing in the spinal canal and makes more space for the nerves to pass out of the spinal joints.
He may remove the overgrowths of bone and shave bony spurs. This spinal de-compression may be needed at several levels.
Minimal Invasive surgery………A new surgical concept for the treatment of spinal instability, failed disc disease or spondylolisthesis. Under general anaesthetic and through tiny keyholes in your back the doctor can introduce one of a range of metallic spring devices which fix onto the spine with screws.
The device is designed to support failing joints in the back whilst maintaining normal back movements. The range of devices are said to be dynamic i.e.: designed to mimic the normal range of flexion in your spine.
These new operations may avoid the need to open up the back and perform major surgery along with bone grafting to fuse parts of the spine.
The new advances mean a much shorter hospital stay and much faster recovery period. The device is designed to allow for flexibility and movements of your back and allows you to regain your normal life.
Depending of the diagnosis and conditions of each individual, the above operations are , but to a percentage. In many cases, the standard operations mentioned before will apply.
Do you know what is causing your back pain?
Dr Bañuls is pleased to offer .......
A New Chronic Back pain diagnosis clinic,
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This offer is exclusive to us and the service started in January 2011.
This new service is open to all new patients with a history of more than six months of chronic or repeated episodes of back pain.
The package of care includes full assessment with
This offer is subject to conditions.our Physiotherapist,
an MRI scan,
an X-Ray of the back and
a clinic appointment with our Specialist to review the results and discuss your options for future treatments.
Please call or contact us by email for more information and to book your place with our promotional pricing.
For Appointments or for more information please call: 606 914 833
Or Email : t.banuls@terra.es
