Sciatica Diagnosis & Treatments
How is Sciatica Diagnosed?
A thorough and accurate diagnosis is key to selecting the best treatment options. A comprehensive diagnostic workup consists of the following:
- Medical History – An assessment of symptoms and previous treatments and care
- Physical Examination – An examination by a spine-trained specialist to ascertain any limitations of movement, problems with balance and pain. The exam should also cover loss of reflexes in your extremities, muscle weakness, loss of sensation or signs of spinal cord damage.
- Diagnostic Tests – Generally, a spine specialist will start with an X-ray film, which allow them to rule out other problems such as infections and deformity of the spine. CT scans and MRIs are often used to give the your doctor three-dimensional views of the lumbar, cervical and thoracic spine and can help detect herniated discs that could be causing the sciatic pain.
What Are The Treatment Options For Sciatica?
Most cases of herniated disc do not require surgery. Clinical research suggests that the pain associated with a herniated disc often subsides without surgical intervention within 4-6 months. If any or all of these symptoms are present you should seek a professional medical opinion quickly.
- Medications: muscle relaxers, non-steroidal anti-inflammatory drugs (NSAIDS) and on rare occasions with extreme pain, narcotic medications
- Heat/cold Therapy: alternating during the first 24-48 hours.
- Physical Therapy: exercise, stretching, massage, and strengthening
- Epidural Steroid Injections: are used two-fold, first to relieve inflammation of the affected exiting spinal nerve and secondly, used as a diagnostic tool to confirm the affected level at which the pain originates from.
Least Invasive Procedures
Once conservative measures have been exhausted, and the patient is still in considerable pain after 6 months, then a minimally invasive procedure may be recommended. The following procedures has shown good results in minimizing in most cases and alleviating pain altogether in some cases:
- Endoscopic Discectomy – A ¼ inch incision is made and a 7mm operating tube is placed in the disc at the site of the annular tear. An endoscope with an HD camera is inserted into the operating tube to visualize the annulus and spinal nerves. Then the tear is debrided to make sure no nucleus pulposus is stuck within the annulus and thermally heated with bipolar instrument to reduce and close the tear.
Minimally Invasive Spine Surgery
- MIS Microdiscectomy – Usually an open procedure or using tubular retractor with an incision of 1 inch. The surgeon usually observes through a microscope or set of eyeglass loupes that help magnify the anatomy. Most of the pain, post-operative, is from the approach the surgeon made through muscle in your back. Anesthesia is necessary.
- MIS TLIF – The surgery involves removing the damaged intervertebral disc and replacing it with a piece of bone or PEEK cage packed with bone, to assist in union or fusion of the two vertebral bodies over time. Screws are used to hold the disc still until it fuses.
How Long Is The Recovery?
With Least Invasive Procedures, most patients can begin getting out of bed one hour after surgery, and go home shortly afterwards. There will probably be some pain after the procedure, usually localized to the incision site. However, just because there is less or no pain, always consult your physician before beginning any physical work.
At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. However, pain and discomfort should begin to reduce within a couple of days after surgery. Most patients can return to administrative duties at work after a few days rest. Full return to active lifestyle and physical work should be about a month.
On the other hand, Minimally Invasive Surgery, most patients will recover from anesthesia for a couple of hours and depending on pain control go home that day or stay the night in the hospital. Some pain and discomfort is normal as you recover in the hospital and at home.
At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a few weeks after surgery. The doctor will discuss with you other techniques for reducing pain and increasing flexibility before you leave for home. The doctor will also discuss with you a time frame for when you can resume basic activities such as walking, driving and light lifting, and when you can return to more advanced activities such as physical labor, sports and yard work.
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