Sciatica
By JAMA.
Diagnosis
» Complete history & physical examination to locate irritated nerve root.
» X-rays to detect spondylolisthesis (vertebral misalignment), narrowed discs, or erosion suggesting spinal tumors; cannot detect herniated disc.
» MRI allows visualization of IV discs, ligaments, muscles, & tumors.
» CT myelography using contrast dyle injected into the spine allows visualization of the spinal cord & nerves.
Treatment
» Analgesics (NSAIDs, steroidal drugs/injection).
» Physical therapy.
» Surgery if all else fails, if symptoms have progressed, or if bladder/bowel incontinence occurs.
Sciatica
By Mayoclinic.
Diagnosis & Investigation
» History.
» Physical exam.
» Spinal X-ray.
» MRI.
» CT scan.
Complications
» Potentially cause permanent nerve damage
»»» Loss of feeling
»»» Loss of movement
»»» Loss of bowel/bladder function
Treatment & Drugs
» Self-care measures proven effective.
» Physical therapy.
» Prescription drugs
»»» NSAIDs
»»» Muscle relaxant
»»» Narcotics
»»» Tricyclic antidepressants
»»» Anticonvulsants
The Big Guns
» Epidural steroid injections. (corticosteroids)
» Surgery. (lumbar laminectomy, discectomy, microdiscectomy)
Prevention
» Regular exercise.
» Proper sitting posture.
» Good body mechanics.
Lifestyle & Home Remedies
» Avoid aggravating activities.
» Cold packs.
» Hot packs.
» Stretching.
» Over-the-counter drugs. (analgesics)
» Regular exercise.
CAM
» Acupuncture.
» Chiropractic.
» Massage.
» Hypnosis.
IV Disc Herniation
By AANS.
Lumber Spine Herniation
» Sciatica frequently results.
» Pressure on the nerves preceding the sciatic nerves causes pain, burning, tingling, & numbness that radiates from the buttock into the leg & sometimes the foot.
» Usually unilateral.
» Pain described as sharp & electric shock-like
» May be aggravated on standing/walking/sitting.
» Associated with low back pain.
Cervical Spine Herniation
» Sharp pain in the neck/between the shoulder blades, radiating down the arm to the hand/fingers.
» Numbness & tingling in the shoulder/arm.
» May be aggravated by certain positions/neck movements.
Diagnosis
» History.
» Symptoms.
» Physical examination.
» X-ray
»»» Shows vertebrae structure & joints outline; obtain to search for other potential causes of pain (tumour, infection, fracture etc.)
» CT/CAT scan
»»» Shows shape & size of spinal canal, its contents, & surrounding structures.
» MRI
»»» Shows spinal cord, nerve roots, & surrounding strucutres; also enlargement, degeneration, & tumours.
» Myelogram
»»» Shows pressure on spinal cord/nerves due to herniated discs/bone spures/tumours.
» Electromyogram & Nerve Conduction Studies
»»» Indicate ongoing nerve damage/healing nerve from past injury/nerve compression.
Treatment
» Surgery not usually required.
» Initial treatment conservative & non-surgical
»»» Bed rest
»»» Maintain period of low, painless activity level
»»» NSAIDs
»»» Epidural steroidal injection
»»» Physical therapy (pelvic traction, gentle massage, ice & heat therapy, ultrasound, electrical muscle stimuatlion, & stretching exercise)
Surgery
» Alternative if conservative methods fail
» Considerations for candidacy
»»» Back & leg pains limits normal activity/impairs quality of life
»»» Development of progressive neurological deficits
»»» Bowel & bladder incontinence
»»» Difficulty standing/walking
»»» Medication & physical therapy ineffective
»»» Patient in reasonably good health
» Surgical options
»»» Artificial disc surgery - surgical replacement of the injured lumbar disc with a manufactured one
»»» Discectomy - complete/partial surgical removal of an IV disc
»»» Laminectomy - surgical removal of most of the lamina of a vertebra
»»» Laminotomy - an opening made in a lamina to relieve pressure on nerve roots
»»» Spinal fusion - bone is grafted onto the spine, creating a solid union between two or more vertebrae.
Lumar Spine Surgery
» Lumbar laminotomy
»»» Incision down the center of the back over site of herniated disc
»»» Muscles moved to expose vertebrae
»»» Small opening made between the 2 vertebrae to gain access to gain access to herniated disc
»»» Disc is removed via disecectomy
»»» Spine is stabilized, often via spinal fusion
» Lumbar laminectomy
»»» For more involved cases
» Artificial disc surgery
»»» Incision made through abdomen
»»» Damaged disc removed & replaced
»»» Strict conditions for candidacy
»»»»» Must have disc degeneration in only 1 disc, between L4 & L5;
»»»»» Must have undergone at least 6 months of treatment without signs of improvement
»»»»» Must be in overall good health without infection/osteoporosis/arthritis
Cervical Spine Surgery
» Surgery about the neck (posterior/anterior) depends on the exact location of the herniated disc & the experience & preference of the surgeron.
» Laminotomy followed by discectomy , subsequently spine stabilization.
Postsurgery
» Specific instructions on physical activity & pain medication prescribed.
Piriformis Syndrome
By NNDS.
The Nut Shell
» Rare neuromuscular disorder.
» Piriformis muscle compresses/irritates the sciatic nerve.
» Pain is aggravated by prolonged sitting/climbing stairs/walking/running.
Treatment
» Stretching exercises.
» Massages.
» Anti-inflammatory drugs.
» Cessation of aggravating activities.
» Corticosteroid injection at junction of piriformis-sciatic nerve.
» Surgery.
Prognosis
» Two thumbs up.
By JAMA.
Diagnosis
» Complete history & physical examination to locate irritated nerve root.
» X-rays to detect spondylolisthesis (vertebral misalignment), narrowed discs, or erosion suggesting spinal tumors; cannot detect herniated disc.
» MRI allows visualization of IV discs, ligaments, muscles, & tumors.
» CT myelography using contrast dyle injected into the spine allows visualization of the spinal cord & nerves.
Treatment
» Analgesics (NSAIDs, steroidal drugs/injection).
» Physical therapy.
» Surgery if all else fails, if symptoms have progressed, or if bladder/bowel incontinence occurs.
Sciatica
By Mayoclinic.
Diagnosis & Investigation
» History.
» Physical exam.
» Spinal X-ray.
» MRI.
» CT scan.
Complications
» Potentially cause permanent nerve damage
»»» Loss of feeling
»»» Loss of movement
»»» Loss of bowel/bladder function
Treatment & Drugs
» Self-care measures proven effective.
» Physical therapy.
» Prescription drugs
»»» NSAIDs
»»» Muscle relaxant
»»» Narcotics
»»» Tricyclic antidepressants
»»» Anticonvulsants
The Big Guns
» Epidural steroid injections. (corticosteroids)
» Surgery. (lumbar laminectomy, discectomy, microdiscectomy)
Prevention
» Regular exercise.
» Proper sitting posture.
» Good body mechanics.
Lifestyle & Home Remedies
» Avoid aggravating activities.
» Cold packs.
» Hot packs.
» Stretching.
» Over-the-counter drugs. (analgesics)
» Regular exercise.
CAM
» Acupuncture.
» Chiropractic.
» Massage.
» Hypnosis.
IV Disc Herniation
By AANS.
Lumber Spine Herniation
» Sciatica frequently results.
» Pressure on the nerves preceding the sciatic nerves causes pain, burning, tingling, & numbness that radiates from the buttock into the leg & sometimes the foot.
» Usually unilateral.
» Pain described as sharp & electric shock-like
» May be aggravated on standing/walking/sitting.
» Associated with low back pain.
Cervical Spine Herniation
» Sharp pain in the neck/between the shoulder blades, radiating down the arm to the hand/fingers.
» Numbness & tingling in the shoulder/arm.
» May be aggravated by certain positions/neck movements.
Diagnosis
» History.
» Symptoms.
» Physical examination.
» X-ray
»»» Shows vertebrae structure & joints outline; obtain to search for other potential causes of pain (tumour, infection, fracture etc.)
» CT/CAT scan
»»» Shows shape & size of spinal canal, its contents, & surrounding structures.
» MRI
»»» Shows spinal cord, nerve roots, & surrounding strucutres; also enlargement, degeneration, & tumours.
» Myelogram
»»» Shows pressure on spinal cord/nerves due to herniated discs/bone spures/tumours.
» Electromyogram & Nerve Conduction Studies
»»» Indicate ongoing nerve damage/healing nerve from past injury/nerve compression.
Treatment
» Surgery not usually required.
» Initial treatment conservative & non-surgical
»»» Bed rest
»»» Maintain period of low, painless activity level
»»» NSAIDs
»»» Epidural steroidal injection
»»» Physical therapy (pelvic traction, gentle massage, ice & heat therapy, ultrasound, electrical muscle stimuatlion, & stretching exercise)
Surgery
» Alternative if conservative methods fail
» Considerations for candidacy
»»» Back & leg pains limits normal activity/impairs quality of life
»»» Development of progressive neurological deficits
»»» Bowel & bladder incontinence
»»» Difficulty standing/walking
»»» Medication & physical therapy ineffective
»»» Patient in reasonably good health
» Surgical options
»»» Artificial disc surgery - surgical replacement of the injured lumbar disc with a manufactured one
»»» Discectomy - complete/partial surgical removal of an IV disc
»»» Laminectomy - surgical removal of most of the lamina of a vertebra
»»» Laminotomy - an opening made in a lamina to relieve pressure on nerve roots
»»» Spinal fusion - bone is grafted onto the spine, creating a solid union between two or more vertebrae.
Lumar Spine Surgery
» Lumbar laminotomy
»»» Incision down the center of the back over site of herniated disc
»»» Muscles moved to expose vertebrae
»»» Small opening made between the 2 vertebrae to gain access to gain access to herniated disc
»»» Disc is removed via disecectomy
»»» Spine is stabilized, often via spinal fusion
» Lumbar laminectomy
»»» For more involved cases
» Artificial disc surgery
»»» Incision made through abdomen
»»» Damaged disc removed & replaced
»»» Strict conditions for candidacy
»»»»» Must have disc degeneration in only 1 disc, between L4 & L5;
»»»»» Must have undergone at least 6 months of treatment without signs of improvement
»»»»» Must be in overall good health without infection/osteoporosis/arthritis
Cervical Spine Surgery
» Surgery about the neck (posterior/anterior) depends on the exact location of the herniated disc & the experience & preference of the surgeron.
» Laminotomy followed by discectomy , subsequently spine stabilization.
Postsurgery
» Specific instructions on physical activity & pain medication prescribed.
Piriformis Syndrome
By NNDS.
The Nut Shell
» Rare neuromuscular disorder.
» Piriformis muscle compresses/irritates the sciatic nerve.
» Pain is aggravated by prolonged sitting/climbing stairs/walking/running.
Treatment
» Stretching exercises.
» Massages.
» Anti-inflammatory drugs.
» Cessation of aggravating activities.
» Corticosteroid injection at junction of piriformis-sciatic nerve.
» Surgery.
Prognosis
» Two thumbs up.
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