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Although sciatica is a relatively common form of low
back pain and leg pain, the true meaning of the term
is often misunderstood. The sciatic nerve is a collec-
tion of several nerves which exit the lumbar spine as
seen in the photo above.
Sciatica is actually a set of symptoms rather than a
diagnosis for what is irritating the root of the nerve,
causing the pain. This point is important, because
treatment for sciatica or sciatic symptoms will often
be different, depending upon the underlying cause of
the symptoms which Dr. Pazmiño can diagnose.
What parts of your spine affected?
Vertebrae.
These are the bony blocks which make up the front
part of our spine, and are stacked on top of each other. These
bones connect posteriorly to create a canal which protects the
spinal cord and nerves.
Spinal cord and nerves.
These work as “electrical cables”
which travel through the spinal canal carrying messages from
your brain to your muscles.
Intervertebral discs are the shock absorbers of the spine.
These work similar to the shock absorbers of your car. They are
made up of two components which provide the shock absorption.
Annulus fibrosus.
This is a tough flexible outer ring of the disc,
which functions to keep the shock absorber well contained in the
middle of the disc where it belongs.
Nucleus pulposus.
This is a soft jelly like center of the disc. This
functions as a shock absorber much like the air bag or foam part
of your sneakers.
Sciatica is generally caused by the compression of
lumbar nerves L4 or L5 or sacral nerves S1, S2 or
S3, or far less commonly, by compression of the sci-
atic nerve itself.
How does it happen?
In many cases herniated disc is related to the natural aging of
your spine. In children and young adults these discs have a high
water content and function as excellent shock absorbers. As we
get older our discs begin to dry out and weaken. This happens
to everyone. A disc herniates when its jellylike center pushes
against its outer ring. If the outer ring is worn or injured the jel-
lylike center may squeeze all the way through.
When the herniated disc bulges out toward the spinal canal, it
puts pressure on the sensitive spinal nerves
Symptoms.
This will pinch the nerves going into
your legs. In this case the pain from
a herniated disc will be from sciatica.
Sciatica
is a sharp often shooting
pain that extends from the buttocks
down the back of one or both legs.
Numbness, tingling, and weakness in
one leg is also common.
Other Causes.
Stenosis
Annular Fissures
Piriformis Syndrome
Trigger Points
Pseudosciatica
How is it treated?
Some people get relief from symptoms without
surgery.
Rest.
Dr. Pazmiño may prescribe a short period of rest or a
muscle relaxant.
Anti inflammatory medications.
Dr. Pazmiño may rec-
ommend medication to combat the inflammation near and
around the irritated nerves.
Cold and heat.
In certain cases Dr. Pazmiño may
recommend cold compresses or ice which can be applied
several times a day for pain relief. After spasms settle, Dr.
Pazmino may recommend gentle heat in some instances to
relieve further symptoms.
Physical therapy & Massage.
In certain situations Dr.
Pazmiño may recommend a course of physical therapy. He
may design a custom tailored course of exercises which can
strengthen your lower back and abdominal muscles. Dr.
Pazmiño may recommend a particular physical therapist who
can then apply traction which helps relieve pain for certain
herniations.
If your symptoms persist Dr. Pazmiño may request
further imaging , procedures, and possibly surgery.
Epidural steroid injection.
Dr. Pazmiño may
recommend an epidural where steroids are injected near the
nerves of your neck or back to reduce local
inflammation. In certain cases these are very effective in
relieving symptoms.
Lumbar microdiscectomy.
This is the most
common procedure for herniated discs in the lower back.
Microdiscectomy involves removing the herniated part of the
disc and any nearby fragments which are putting
pressure on the nerves. This procedure has provided excel-
lent results in thousands of patients with intractable pain
and is one of the most common procedures performed by
Dr. Pazmiño annually. For more information see our website
www. spinecal .com.
If the herniated disk is in your back: