CONDITIONS AND PROCEDURES
Sciatica
The sciatic nerve, the prominent nerve of the leg, is one of the largest in the body. The nerve's branches feed the hip muscles and the thigh, lower leg and foot muscles.
Sciatic nerves travel from the lower back to the hips, buttocks and legs.
What is sciatica?
Sciatica is severe pain that occurs anywhere along the sciatic nerve path. Usually, with sciatica, only a single side of the body is affected. Sciatica is a condition that develops when a bone spur or herniated disc presses down on a portion of the nerve. Otherwise, spinal stenosis occurs when the spinal canal begins to narrow, and the space in the backbone decreases. As a result, increased pressure is placed on the spinal nerves and spinal cord. Depending on the severity of sciatica, it may require conservative treatment or surgical intervention.
What are the symptoms?
Pain radiating from the lumbar spine/lower back
Pain that worsens when coughing or sneezing
Numbness, weakness or a strange sensation in the affected foot or leg
Pain in the affected leg
How do you treat sciatica?
Sciatic pain can dissipate in a matter of weeks, even without non-operative treatment. However, surgery may be the only option when sciatica worsens, causing severe pain, weakness in the legs, and loss of bowel and urinary control.
Conservative treatment involves taking prescribed medications such as anti-inflammatories, muscle relaxants, tricyclic antidepressants and anti-seizure drugs to reduce sciatic pain. Corticosteroids can be injected near the nerve root. A corticosteroid injection helps relieve pain by reducing inflammation around the irritated nerve.
Surgical treatment involves the following:
- Microdiscectomy is a minor surgical procedure to remove a herniated disc found in the lumbar spine.
- Laminectomy is surgery to dissect a portion of the lamina or the entire lamina to make space for the spinal nerves. A laminectomy boasts over 90 per cent of pain relief in a majority of patients.
- Decompression surgery uses image guidance (x-ray and contrast dye) to resolve lumbar spinal stenosis by removing a portion of the thickened ligament (Ligamentum Flavum) behind the spinal column. Dr Bomela creates more space for the spinal nerves by removing a portion of the dense ligament.
- Foraminotomy is a surgical procedure to extract tissue and bone in the foramen, the space where the nerve roots leave.
- Spinal fusion is a procedure to fuse two or more vertebrae to increase the stability of the spine. A spinal fusion is required when pain radiates from the spinal nerves due to spinal stenosis.
- The placement of spacers is inserted between the bones at the back of the vertebrae, also known as the spinous processes. The spacers create enough distance between the vertebrae, providing more room for spinal nerves.
FAQ
1. How do I know I need surgery to treat sciatica?
Dr Bomela will have to perform surgery when pain in your leg prolongs for over four weeks.
Symptoms that warrant surgery include:
- Bowel or bladder dysfunction due to spinal cord compression or a rare condition called cauda equina syndrome, which is a lower back disorder
- Leg weakness
- Spinal stenosis
2. Does it take long for sciatica to go away after a laminectomy?
You can expect a full recovery between two to four weeks.
3. How do I know I have sciatica?
There are several tests to diagnose sciatica which include the following:
- An MRI scan reveals images of the back’s soft tissue and bone.
- X-rays of the spine reveal fractures, damaged discs, spinal infections and tumours, disc herniation and bone spurs.
- Finally, a myelogram is done to determine whether a vertebral disc is causing sciatic pain.
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