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Sciatica then can come from a variety of causes, things that have to do with your arteries, things that have to do with your nerves, but the common thread is pain that generally starts in the back, goes to the buttock, down the leg, and can be either in the thigh or the calf or any parts thereof. The good news is, is you don’t have to live with Sciatica, and there are a multitude of treatments that work well to get people better, both medically and if necessary, surgically.
Some people try acupuncture for their Sciatica. For some it can be helpful, for some not. The hard part is identifying those patients who are going to respond to it.
For Sciatica caused by nerve problems, many times physical therapy, chiropractic, manipulative therapy can be helpful. One of these manipulative therapies can be decompression in which the spine is stretched, but again, it can be highly variable from patient to patient with the response of who has improvement and who doesn’t.
Don’t be afraid of surgery. The right surgery for the right problem ends in good outcomes. For people with ruptured discs, a small incision at outpatient surgery that lasts about an hour, 95% of people are going to do well with that surgery. For people who are more elderly and have lumbar stenosis where the bone, has gotten very, very thick and squeeze the nerves, they may take longer to recover. But still at one year, 95% of people report happy outcomes and it is maintained over even a decade. After 10 years, 85% of people are still happy with their surgery. But do be careful. You do want to have the right surgery for the right problem.
Many people will ask if their insurance coverage will cover the treatment of their Sciatica. Since Sciatica is a medical problem, it generally is, but insurance plans can vary from patient to patient, region to region, family to family, and so it may not all be covered or it may all be covered depending upon the plan.
Sciatica is everybody. Just about everybody you talk to has had an episode in their life where they have had leg pain from one cause or another. Strictly speaking, the stuff that has to do with ruptured disc and spine origin, though, is still fairly common in the populous and probably 40% of the population will have had Sciatica at sometime in their life.
Many times people will ask, “what can I try it at home?” Over the counter, anti-inflammatories, Ibuprofen, naproxen. Those are choices. Make sure you don’t have a bleeding problem or you don’t have an ulcer before you try that. But generally you could try that for a week or so and see if things get better if it’s not bothering you a lot. Some people will ask about alternative treatments and unfortunately there’s not a big scientific literature about that. A lot of it is what we call anecdotal. Someone tries something and says, “that worked for me.” That may or may not work for you. Unfortunately for acupuncture, it’s very difficult to know. When Nixon came back from China, he brought back acupuncture with him and we think that the patients who do best with acupuncture are the same patients who do best with hypnosis. So the data on the acupuncture situation and how it will treat Sciatica varies enormously from patient to patient.
Sciatica can go away on its own, with medical treatment, with advanced medical treatment, with medicines, with therapy, and with surgery. Depending upon each individual patient, it may take a small amount of time, days, it may take weeks, and for some of the patients, particularly the elderly may take months, particularly after a surgery to really fully regain functionality. What that means is they’ve had troubles walking for a long time and it takes a while to get strong again and build up your walking.
When surgery is necessary, and I emphasize the necessary part because not everybody needs or should have surgery. But there are a variety of, particularly for neurogenic nerve causes of Sciatica, a variety of different surgeries. It may be as simple as an outpatient hour surgery in which a small one inch incision is made for removal of a disc rupture or it may be a longer surgery which may have a six or seven inch incision for someone who has multiple levels of lumbar spinal stenosis seen often in the elderly. Many of these procedures now are done as outpatients rather than as inpatients where people can go home the same day, not have to spend a night in the hospital. The recovery is variable. Many times for the patients who have had outpatient surgeries, going home the same day, they’re up and walking the same day, they’re driving at the end of a week. For some of the more extensive surgeries, people may need to be in a brace for several months, if they’ve had fusion procedures. Fusion is reserved for those patients who either have breaks in their spine or have a spine, which is not aligned properly and would otherwise sort of fall apart if they didn’t have those stabilization devices.
If you are having surgery for your Sciatica, you’ll be pleased to hear that the times in the hospital, the operative times and the times to recovery, have improved dramatically. We’ve come a long way with minimally invasive techniques and other procedures so that patients can be back living their lives all that much sooner.
With Sciatica, there’s some definite warning signs that you should seek almost immediate attention. One of those is, is if you have a neurologic deficit. That’s sort of a funny term, but what that really means is if you have a weak leg or weak legs. You shouldn’t have a weak leg or legs. It needs to be attended to. If you have a blue toe or a toe or a foot that looks like that, it is model that it doesn’t look right, doesn’t look like it’s getting blood flow to it. Also, if you can’t get around and you previously weren’t on a walker and having troubles, and now you are, you have to use a walker or crutches. You need to be seen and evaluated.
For many patients, the initial treatment of Sciatica is with nonsteroidal anti-inflammatory drugs. In trade names, Aleve, and Ibuprofen, and Motrin and Advil, and these can help a majority of patients. If patients are not made better by antiinflammatories, then the next step is often what its called lumbar epidural steroid injections. These are a steroid, again, an antiinflammatory drug that’s injected directly into the spine. The risks of both of these kinds of treatments are very low, and the success rates though are in the 30-40% range, but that’s significant compared to not being made better at all.
So with the diagnosis of Sciatica, the two tests that help us the most are the non-invasive arterial studies and the MRI. If your arterial studies would show arterial blockage are positive, then you’ll need to see a vascular surgeon. But don’t be worried. Not everybody needs surgery and there are many medical treatments for it. For causes that we see on MRI, such as Lumbar stenosis, the bony overgrowth, which squeezes the nerves, or a ruptured disc, or other things that squeezed the nerves, many times, conservative treatment can help before one has to go to surgery.
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