Health Tips

Sciatica is the most common ailment experienced by people during the course of their lives. If the pain is persistent, it can hinder movement, cause stress, and be responsible for a lack of desire to pursue day-to-day activities. It can even be responsible for reduced social interaction.

The cause of sciatica is very often a lumbar disc prolapse or what is more commonly known as a hernia or disc herniation. It is more likely to occur between the ages of 30 – 50 after heavy lifting or falls.

The degeneration of the spine that occurs during the aging process is the primary cause of low back pain although actions such as prolonged standing or sitting at a desk can overextend the low back muscles and damage the lumbar disc.

The intevertebral discs are composed of a soft inner pulp surrounded by a fiber-like outer ring. Several things occur in the disk once degeneration is in progress. The disc is losing liquid, the annulus fibrosis begins to tear. These degenerative changes in the disc result in a disc herniation which irritate the spinal cord or pinches the nerve root.
The symptoms can be low back pain with numbness in the leg, in the area supplied by the nerve that is pinched. The pain is located in the lower leg below the knee and in the foot.

Diagnosis

Diagnosis of disc prolapse can be made by physical examination, CAT scan, MRI scan and nerve conduction test (EMG).

CAT Scan
CAT Scan (Computer Assisted Tomography) A CAT scan is an x-ray that has the advantage of being able to take pictures in “slices” across the spine, thus giving a cross sectional view. This is extremely useful when conditions that affect the bones of the spine are suspected. CAT is extremely useful in evaluating spine trauma as it can quickly detect bone fractures, a disc prolapse and nerve root compression showing exactly where problems are.

MRI (Magnetic Resonance Imaging)
MRI is a modern computerized technique of scanning using a strong magnetic field and radio wave signals instead of radiation used in x-rays to take pictures of the spine thus avoiding harmful radiation effects. These returning signals are converted into pictures by a computer attached to the scanner. Slices of the spine can be taken in any thickness and in any direction without the use of dyes or methods of coloring. The MRI shows detailed anatomy of the body part imaged making the MRI scan the best method for imaging the body.

Myelogram
The myelogram involves the injection of a special contrast medium or dye into the space surrounding the spinal cords and the nerves which arise from it. Pressure on the nerves of the spine such as those caused by a herniated disk will be revealed from any abnormal indentation on the spinal sac. In difficult cases, the myelogram is combined with the MRI in order to see more details. The examination is performed by a radiologist who interprets the information from the procedure, reports it to your doctor, who then discusses the report with you. On the myelogram picture you can see clearly the “defect” of lack of filling, that indicates a disc prolapse.

MRI – Myelogram
Electromyogram (EMG) The electromyogram attempts to ascertain the functioning of the nerve roots that leave the spine. Tiny electrodes are inserted into the muscles of the lower leg and electrical signals in the muscles are measured. The EMG can show if a nerve is being irritated or pinched as it leaves the spine if abnormal electrical signals in the muscles are found. The location of the irritated or pinched nerve can be detected depending on the nerve in the leg muscle that is stimulated by the electrode.

Treatment
Low back pain treatment caused by disc prolapse usually begins conservatively with bed rest, hot packs, physical therapy. Anti-inflammatory drugs (Celebrex) decrease the swelling and inflammation in the spine. For muscle spasms, muscle relaxants are helpful. In difficult cases of acute low back pain with nerve root compression, epidural steroid injections are necessary.

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