Lumbar Disc Protrusion (Sciatica)
Crucial: the right treatment at the right time
Schoen Clinic London specialises in the treatment of acute and chronic disc herniation (disc prolapse). Whether you are seeking an exact diagnosis, conservative treatment or precise disc surgery – you will benefit from the experience of our spine specialists.
Causes & Symptoms
The lumbar spine has a central canal through which the nerve roots and the cauda equina pass. To each side of the canal, spinal nerve roots branch out at every level. The cauda equina and nerve roots are surrounded by cerebrospinal fluid (CSF) and are all contained within a membrane (dura).
There are five bones (vertebra) in the lumbar spine (lower back). In between each bone is an intervertebral disc, which acts as both a spacer and a shock absorber.
Over time, as degeneration (wear and tear) occurs, the intervertebral disc can lose its flexibility, elasticity and shock absorbing characteristics. The tough fibrous wall of the disc may then weaken and split and no longer be able to contain the gel-like substance in the centre.
This material may bulge or push out through a tear in the disc wall (herniation), causing pain when it touches a nerve (sciatica). Symptoms also associated with sciatica include altered sensation, pins and needles, burning, numbness or even weakness of the muscles in the leg that the nerve supplies.
Onsite diagnostic imaging and expertise
It is important to get the right treatment at the right time. Our experienced specialists and modern equipment are the best basis for this.
Searching for the cause of the pain
Pain perception, reflexes, numbness and muscular weakness usually indicate to your consultant where the herniated disc is located and what kind of pressure it exerts on the adjacent nerves.
Imaging methods such as magnetic resonance imaging (MRI), digital x-rays and possibly computer tomography (CT) can give us an exact picture of the bone structure of your vertebrae, where exactly your herniated disc is, and how extensive it is. If the cause of your pain cannot be determined immediately, additional examinations may be needed.
Few people who have a lumbar disc prolapse need surgery. A significant number of people will improve naturally. This can happen if the disc or swelling around a nerve decreases with time or is helped by image-guided injection.
Six out of ten patients can get better spontaneously after six weeks, while 70-80% of patients will feel better by three months.
There is a balance of waiting while nature gets you better, versus waiting too long which might prolong your suffering and pain or compromise nerve function (weakness, numbness or pain recovery). In rare cases the nerves which control your bladder, bowel and sexual function can be compressed. This is known as cauda equina syndrome (CES) and often requires urgent surgical intervention. Fortunately, immediate spinal surgery is only necessary in a few cases.
- Pain medication (analgesics, anti-neuropathics and anti-inflammatory medication)
- Heat therapy
- Soft tissue therapy
Spinal injections (lumbar nerve root block / epidural)
These procedures are carried out as a day case. They are performed under local anaesthetic or sedation. X-ray is used as guidance to direct the needle to the appropriate area of the spine before a small volume of corticosteroid and/or local anaesthetic is injected.
Surgical treatment (Microdiscectomy)
This is performed through an incision in the lower back. First the muscles are held apart to gain access to the bony arch and roof of the spine (lamina). Your surgeon is then able to enter the spinal canal by removing a membrane in between the lamina and over the nerve roots (ligamentum flavum). Often, a small portion of the inside facet joint is removed, both to enable access to the nerve root and to remove pressure on the nerve. A microscope is used to give greater magnification of the structures. The nerve root is then gently moved to the side and the disc material is removed from under the nerve root.
It is very normal to experience some level of discomfort pain after the surgery. The experienced nursing and medical staff at Schoen Clinic will help you to control this with appropriate medication. The symptoms in your legs may fluctuate due to increased swelling around the nerves. As the nerves become less irritated and swollen, your leg pain should settle. This can take a few weeks. The ward physiotherapist will visit you after the operation to teach you exercises and help you out of bed. They will show you the correct way to move safely. Once you are confident and independently mobile, you will be encouraged to keep as mobile as possible. In many cases you will be able to go home the day after surgery.