Suffering From Sciatica Or Lower Back Pain? Here's When You Might Need Surgery

A large number of patients visiting hospitals complaining of lower back pain get diagnosed with sciatica.

We have intervertebral disks with  shock absorbing jelly-like substance present between adjacent vertebrae. However, if this jelly pushes out (herniates) between the vertebrae, it may put pressure on the adjacent spinal nerves that may be very painful. Such disk herniations may occur in the upper, middle, or lower back, explains Dr. Vivek Loomba, Consultant Pain Physician at the Indian Spinal Injuries Centre, New Delhi.

A disk herniation in the upper back may result in neck pain, radiating down into one of the upper limbs. Talking about Sciatica, Dr Loomba says that the term is reserved for excruciating pain radiating from lower back down the leg, and sometimes into the foot, usually resulting from disk herniations in the lower back.

Causes of Sciatica

People in the age group 30 to 50 years are most likely to get a disk herniation. The problem affects men twice as often as women. Other risk factors include:

• Sitting for long periods in the same position
• Overweight/obesity
• Lifting heavy objects
• Lack of physical exercise
• Repetitive bending or twisting motions for work, sports or hobbies
• Smoking

Symptoms of Sciatica

The symptoms may vary from a mild to severe pain in the lower back. Other symptoms include:

• Back pain
• Tingling or numbness in the lower extremities
• Pain in one or both legs
• Muscle weakness
• Loss of bowel or bladder control

Dr. Loomba suggests visiting your doctor if your pain persists for over a few days.

Diagnosis of Sciatica

A disc herniation is diagnosed based on symptoms, clinical evaluation and investigations, including MRI, NCV and EMG. MRI remains the most useful diagnostic investigation for accurate diagnosis.

When do you need surgery for sciatica?

This is a common question that patients ask doctors. Most patients, approximately nine out of every 10, will get significant relief with conservative management or epidural injections, thus avoiding the need of surgery.  However, any patient who develops ‘red flag symptoms’ like weakness in lower extremities, loss of bowel or bladder control, or unable to bear weight needs urgent surgical intervention.

Treatment

The treatment for sciatica includes painkillers like ibuprofen, neuropathic medications like gabapentin or pregabalin, antidepressants like amitriptyline, steroids, physiotherapy and back strengthening exercises.

Dr Vivek Loomba says that if the symptoms persist, an interlaminar or transforaminal epidural steroid injection may prove to be very useful in relieving the symptoms and providing good relief. A pain management physician performs these procedures under x-ray guidance to target the site of disc herniation. These procedures have a proven safety record, provide excellent pain relief, and also help in avoiding the need of a surgical procedure.

In some patients, surgical procedures like discectomy and laminectomy are warranted.  

Prevention of Sciatica

A healthy lifestyle will help in preventing sciatica to some extent. This includes:

• Regular physical exercise
• Maintain a healthy weight
• Avoid prolonged sittings
• Avoid smoking

Sciatica is a painful condition that is treatable without surgery in most cases. Please consult your doctor if you experience symptoms of sciatica, and do consider epidural injections by a physician.

Image credits- freepik