As mentioned in the previous article, sciatica refers to pain in the lower limbs caused by compression or irritation of the nerve roots that supply the legs at the level of the spine. This article focuses on the causes and treatment of sciatica.
The sensory nerves supplying the lower limbs travel to the lumbar spine. The lumbar spinal canal is relatively narrow, and if the tissues around the canal proliferate or swell, the nerve roots become compressed. At the same time as compression occurs, an inflammatory reaction develops around the nerve roots, which stimulates the sensory nerves and causes pain. Because these nerves supply the lower limbs, even though the problem originates in the lumbar spine, the pain is felt in the legs. Common causes of nerve compression include herniated discs, joint hypertrophy (bone spurs), and ligament hypertrophy.
Most cases of sciatica recover naturally over time. If symptoms are mild and there is no severe nerve compression or damage, patients may try conservative treatments such as medication, acupuncture, and physiotherapy.
If the pain is severe and does not respond to conservative treatment, the patient may need interventional treatment. Interventional treatment can be understood as a procedure that does not require open surgery: under X-ray guidance, the doctor injects medication directly at the site of nerve compression to reduce inflammation and control pain. For refractory pain, the doctor may, under X-ray guidance, place a pulsed radiofrequency device beside the nerve cells to treat the area, reducing the nervous system’s response to pain.
If the nerve is severely compressed and damaged, the patient may need open surgery to remove the proliferated or swollen tissue.
In some people, symptoms improve temporarily after surgery but then gradually return. This may be because adhesions (scar tissue) caused by the surgery re-compress the nerve. The doctor may need to use interventional treatment to release the adhesions. If this proves ineffective, the doctor may use a spinal cord stimulator, which uses a continuous electrical current to stimulate the nerve and control pain.
Lee Yuk-ming
Specialist in Pain Medicine
Original article: Health: Caring for the Elderly — Sciatica (Part 2): Causes and Treatment of Sciatica | Oriental Daily | Local News
Published in Oriental Daily on 24/02/2022
Source: https://orientaldaily.on.cc/content/news/odn-20220224-0224_00176_247/
