Disks act as shock
absorbers between the lumbar vertebrae. Overtime due to aging, injury and genetics the disks dry out and breakdown. This is called degenerative disk disease. If the outer shell of the disk (annulus fibrosis) weakens or ruptures (breaks) the inside of the disk (nucleus pulposus) can ooze out and pinch a nerve
causing back and leg pain
). This is called a disk herniation. Most cases of sciatica will resolve in 2 to 3 months.
The usual treatment is short term nsaids
(for a couple weeks), physical therapy
, steroid injections and surgery.
I usually do not recommend long term NSAID treatment for back pain or sciatica due to the risks of stomach ulcers, kidney and heart problems
, but not limited to these problems. I find they work best for short term use (1 to 2 weeks) during a bad flare-up of the pain. If the NSAID does not help the pain then i recommend stopping it. I would discuss your particular NSAID usage with your doctor.
If people are still having problems after multiple rounds of physical therapy and do not get much relief i recommend stopping the physical therapy.
If you have fail conservative treatment, you may be a good candidate for spinal steroid injections. They can provide short term or long term relief. Since most people will improve over 2 to 3 months they can get you "over the hump" until the body naturally heals itself.
Patients who fail all the above treatments, have severe pain and disability and/or neurologcial dysfunction may consider surgery. Back surgery
should be viewed as the last resort in most circumstances. It is best not to rush into it, but some times it is necessary. Age is a consideration, but it is not the only consideration when deciding on surgery.
Today back surgery for disk herniations is much different then it was 20 years ago. In the past most back surgeries were done open requiring a large skin incision
, large muscle retraction, bone removal
and nerve retraction. Today lumbar disk herniations can be removed endoscopically (sometimes referred as laser) through a small 7 mm tube with a micro camera and instruments. The advantagaes of endoscopic surgery are no general anesthesia
, very small skin incision, minimal muscle and bone damage, less postoperative pain and shorter recovery.