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Sciatica Treatment
in Hyderabad

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Sciatica Treatment
in Hyderabad

Sciatica is a chronic pain conditions in which the patient have pain in low back and buttock radiating down to the leg and toes. The pain is occurring due to inflammation in the sciatic nerve which is thickest nerve of the body and runs from back of the buttock till the leg. Usually the pain will be on one leg only but rarely there can be pain in both the legs. There is nerve compression or pinching occurring due to herniated disc or any bony spur compressing the nerve or due to spinal canal stenosis. The pain is dull aching pain or a shooting kind of pain may or may not be associated with tingling and numbness.

Symptoms

Patient will have a radiating pain from buttock to back of the leg. There will be continuous pain along the nerve path. The pain is dull aching or throbbing or may be like electric shock like which may or may not be associated with features like tingling and numbness in the leg or foot. The pain will initially be mild and then slowly can become severe which will increase on walking . Patients with RED FLAGS (weakness of the leg or having urinary and bowel
incontinence ) are candidates for immediate surgery. The pain increases on walking and standing and subsides on resting or sitting.

Risk factors

like old age, obesity , heavy physical activity, prolonged sitting .

Causes

Several spinal disorders can trigger this condition. Medical conditions that may cause sciatica
include:

  • Herniated lumbar disc (a condition in which the inner portion of the  spinal disc protrude through the outer ring)
  • Lumbar spinal stenosis (an abnormal narrowing of the lower spinal canal )
  • Spondylolisthesis (a spinal condition in which one of the lower vertebrae slides forward onto the bone beneath it)
  • Lumbar degenerative disc disease
  • Piriformis syndrome (a neuromuscular disorder develops when the piriformis muscle irritates the sciatic nerve)
  • Spinal tumor
  • Osteoarthritis
  • Bone spur (overgrowth of bone)

How can we prevent this condition?

Maintaining a good body posture, regular exercises, drinking adequate water, avoid smoking are few preventive measures.

How to diagnose this condition

Clinical history and examination done by the physician to elicit the cause of pain.

Straight leg raising test is done which is usually sensitive but not very specific. Other tests like heel walking and toe walking is checked for any weakness of the legs, temperature and sensations are checked on both the sides.

MRI of spine is done to identify the herniated disc and nerve compression, spinal canal diameter, spinal canal stensois, and is considered the gold standard for diagnosis of herniated disc.

X-Ray of the spine can also be done to identify any bony over growth compressing the nerve but it does not help much in diagnosis.

Treatment

Nonsurgical treatment options include:
Medications:

  • Non-steroidal anti-inflammatory drugs(NSAIDs)– Lot of over the counter pain killers are available which are helpful in decreasing the acute inflammation but its long term use is associated with complications like renal and liver dysfunction, Gastritis . They have to be used under the supervision of treating doctor for small period of time.
  • Muscle Relaxants– Neck muscles goes into spasm and stiffness which restricts the neck movements. Muscle relaxants helps in relieving these spasms for short while.
  • Corticosteroids– The role of steroids come in severe cases of pain because of its anti- inflammatory action. Steroids may sometimes be helpful in this condition but should be taken only when prescribed by the physician .
  • Antineuropathics like Pregabalin and Gabapin plays important role in decreasing the pain signals carried by the nerve around the cervical spine. These medications are taken for few weeks and side effects are seen early in its course. Drowsiness, dizziness are the initial side effects seen which eventually subsides in due course of time. These medicines have good efficacy in such cases.
  • Antidepressants– Nortryptiline aor Amytriptiline in small doses also helps t relieve such pain.

Physical therapy:

Certain low back stretching exercises are recommended to strengthen the back muscles. These Exercises are to be avoided in cases of acute pain as doing these exercises may exacerbate the pain.

Ice, heat and massage therapy: These therapies help to relieve pain, stiffness and inflammation for short term. They are not a permanent solution for this condition .

Surgery-

Surgery is required only in case of severe pain or occurrence of RED FLAGS- Weakness of legs, urine and bowel incontinence. Surgery is associated with major complications like recurrent disc herniation, instability of spine , increased load on facet joint and sacroiliac joints.

ADVANCED TREATMENT

Non Surgical Treatment
Nerve blocks for Sciatica

Epidural Injections – epidural injections can be taken to decrease the inflammation around the sciatic nerve. This procedure is done in operation theatre this is usually gives permanent relief to the patient but sometimes repeat injection may also be required. This is done as a non surgical treatment and is gives the best results among all the available modalities of treatment .

ADVANATGES OF EPIDURAL INJECTIONS

  • Non Surgical treatment
  • Day Care treatment
  • Result similar to that of surgical intervention
  • No complications in near and late future
  • Immediate pain relief
  • No changes in the normal anatomy of the spine and hence no loss of spine stability

MYTHS ABOUT EPIDURAL INJCETIONS-

Epidural injections may cause future problems

Epidural injections when done under fluoroscopic guidance and done with precision by a qualified doctor has no long term complications

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