Lower Back (Lumbar) Surgery

Sciatica
is a common type of pain affecting the sciatic nerve, which extends from the lower back all the way through the back of the thigh and down through the leg. Depending on where the sciatic nerve is affected, the pain may also extend to the foot or toes. Usually only one side of the lower body is affected.

Causes
Sciatica most commonly occurs when a herniated disk or a
bone spur on the spine compresses part of the nerve causing
inflammation, pain and numbness in the affected leg.

  • Irritation of the roots of the lower lumbar and lumbosacralspine
  • Lumbar spinal stenosis (narrowing of the spinal canal)
  • Degenerative disc disease (breakdown of discs, which act as cushions between the vertebrae)
  • Spondylolisthesis (a condition in which one vertebra slips forward over another one)
  • Piriformis Syndrome
  • More rarely, the nerve can be compressed by a tumor or damaged by a disease such as diabetes.

What are the symptoms?

  • Pain – vary widely from a mild ache to a sharp, burning sensation or excruciating discomfort. Sometimes it may feel like a jolt or electric shock. It may be worse when you cough or sneeze, and prolonged sitting can aggravate symptoms.
  • Tingling, weakness and numbness.
  • Difficulty moving the leg or foot.

Statistics
Sciatica is relatively common affecting 15% to 40% people during their lifetime. This incidence is related to age, rare before 20 y/o,the highest incidence is found in the fifth decade and then decreases with increasing age. Regular walking also was found to increase the incidence of sciatica. In addition, occupations with greater physical labor, such as carpenters and machine operators, have a higher likelihood of developing sciatica compared to less mobile office workers.

Risk factors for sciatica include:
Age
Obesity
Occupation
Prolonged sitting
Diabetes affects the way your body
uses blood sugar, increases your risk of nerve damage.

Complications
Nerve damage
Loss of feeling in the affected leg
Weakness in the affected leg
Loss of bowel or bladder function

Diagnosis
The most applied diagnostic test is the straight leg raise to produce Lasègue’s sign, which is considered positive if pain in the distribution of the sciatic nerve is reproduced with between 30 and 70 degrees passive flexion of the straight leg. While this test is positive in about 90% of people with sciatica, approximately 75% of people with a positive test do not have sciatica.
– http://www.youtube.com/watch?v=GEm9TzkVPQQ
– Imaging tests such as CT or MRI can help with the diagnosis of lumbar disc herniation.

Treatments and drugs

  • Medications: Anti-inflammatory, Muscle relaxants.
  • Steroid injections: Corticosteroids help reduce pain by suppressing inflammation around the irritated nerve.
  • Surgery
  • Physical therapy (see next slide)
  • Accupuncture
  • Chiropractic

Physical Therapy

  • Posture correction – Pay special attention to your core muscles — the muscles in your abdomen and lower back that are essential for proper posture and alignment.
  • Back support
  • Good body mechanics

Physical Therapy

  • Exercise is usually better for relieving sciatic pain than bed rest. Patients may rest for a day or two after their sciatic pain flares up, but after that time period, inactivity will usually make the pain worse.
  • Without exercise and movement, the back muscles and spinal structures become weak and less able to support the back, that can lead to back injury and strain, which causes additional pain.
  • Active exercise is important for the health of the spinal discs. Movement helps exchange nutrients and fluids within the discs to keep them healthy and prevent pressure on the sciatic nerve.
    • Exercises

    • Incorporate strengthening, stretching and aerobic activities -they are central components of almost any sciatica treatment plan.
    • Stretching is usually recommended to alleviate sciatic pain (Piriformis and hamstrings)
    • Strengthen the spinal column and the supporting muscles, ligaments and tendons,the abdominal muscles, gluteus and hip muscles.
  • (McKenzie exercises and Dynamic Lumbar Stabilization)

    Physical Therapy

    • Ultrasound– decrease healing time and relieve stiff and inflexible muscles by improving the circulation and gently heating the muscles.
    • Massage –deep and firm massage will not only help soothe those cramped muscles but can actually make the nerves and ligaments both relax.
    • Transcutaneous Electrical Nerve Stimulation – In some cases using a very small and controlled amount of electricity can decrease the intensity and number of muscle spasms and can help release pain blocking endorphins, much like aerobics.