Posted on September 29, 2024
For the many people who suffer with sciatica, this nagging, continuous ache can create much misery.
Sciatica is pain radiating down the leg from inflammation or pressure on the sciatic nerve. Sometimes, it only travels from the low back to the buttock, but usually goes to the outer calf and foot.
Sciatica may originate from a disc protrusion, disc herniation, bony narrowing of the nerve root canal, leaky disc or other causes.
A common cause of sciatica is a bulging, protruding or herniated disc. An experienced interventional pain management physician knows when even a simple protruding or bulging disc may be the source of the back and leg problem.
A bulging or protruding disc is a sign of disc deterioration. The disc bulges because the structure of the disc has become compromised, and it ceases to function properly.
As the disc “pancakes” outward, it may touch and irritate an adjacent nerve root. As the disc continues to deteriorate, chemicals may leak from it. This can cause inflammation of the sur-rounding nerve roots, which results in sciatic pain.
MRIs are the main diagnostic tool and gold standard for detecting the source of the sciatica. This study, when interpreted correctly with an understanding of the patient’s exact pain, can help diagnose the exact source of the pain, and thus determine the correct level to be treated.
Epidural steroid injections are commonly used to treat sciatica. To relieve inflammation, a high concentration of the steroid (an anti-inflammatory) must reach the inflamed nerve roots.
Treatment success is maximized when these injections are performed under x-ray guidance (fluoroscopy). This allows the physician to guide the path of the needle to the exact target, ensuring that the medication reaches the precise location along the affected nerve.
Injections are usually performed without the need for anesthesia. However, local anesthetic is injected along with the steroid to temporarily alleviate any pain.
When a simple midline epidural is performed, the medicine may not get close enough to the irritated nerve root. For this reason, skilled pain management physicians often perform transforaminal epidural steroid injections.
This technique places concentrated doses of steroid right next to the irritated nerves. It often involves testing several exiting nerve roots to see which one is most affected.
Once the offending nerve root has been determined, steroid is administered to “turn off” the inflammation causing the pain. This very selective epidural injection ensures that the medicine reaches the affected nerve root in the highest concentrations possible.
Transforaminal steroid injections can also be used to treat sciatica in patients who have had previous back surgery and still have persistent or recurrent leg pain. Or, it can be used to treat sciatica in patients who are on blood thinners, since the needle is not entering the central spinal canal.
Medical studies have shown that leg pain associated with lumbar disc protrusions can often be successfully treated with epidural injections.
In fact, for routine disc herniations, there is no difference in long term (6 months to 1 year) outcome when injections and physical therapy are compared with surgery.
However, if injections are not successful in alleviating your pain, an option may be minimally-invasive spine surgery to easily remove the disc protrusion, take pressure off the nerve and return you to work within several days.
Transforaminal epidurals and minimally invasive disc procedures have revolutionized pain management. These advanced techniques have allowed many patients to return to a relatively pain-free life.
We find that many long-term sciatica sufferers are unaware such procedures can resolve or minimize discomfort that has persisted for months, or even years.