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Sciatica

Management of sciatica

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.

Conservative

  • Pain medication (analgesics, anti-neuropathics and anti-inflammatory medication)
  • Physiotherapy
  • Heat therapy
  • Soft tissue therapy
  • Exercise
  • 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.

Microdiscectomy surgery

If conservative methods or pain medication alone are not sufficient, our specialists may carry out a microdiscectomy spine surgery.
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 a 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.

Non-operative treatment of sciatica

  • Pain medication
  • Physiotherapy
  • Heat therapy
  • Soft tissue therapy
  • Exercise
  • Spinal injections

Surgical management

  • Microdiscectomy surgery