Posted on November 29, 2018
We all have occasional aches and pains. Overused muscles or minor mishaps can cause temporary discomfort. However, for people who suffer with sciatica, the nagging, frequent ache can interfere with leading active lives.
Pain radiating from inflammation of the sciatic nerve, or sciatica, has many causes. It may originate from a herniated disc or spinal stenosis (narrowing of the spinal canal) or from less serious conditions.
A common cause of sciatica is a bulging disc. An experienced interventional pain management physician knows that a simple bulge is not a simple problem. In diagnosing the cause of leg and back pain, a bulging disc is often overlooked, yet may be the true culprit.
A bulging disc is a sign of disc deterioration. The disc bulges because it has lost some of its height. As it “pancakes” outward, it may touch and irritate the adjacent nerve root. As the disc continues to deteriorate, chemicals may leak from it. This can cause inflammation of the surrounding tissues, which results in sciatic pain.
X-rays and MRIs are the main diagnostic tools for detecting a bulging disc. However, they do not always identify the problem. MRIs are normally performed while the patient is lying down. Yet, many people with back pain or sciatica do not have pain when lying down.
Therefore, a truer assessment can be by performing MRIs with the patient sitting or standing. This allows the added weight of the spinal column to reveal how their disc bulges as it expands into a protrusion. This can reproduce the pain that the patient actually experiences on a day-to-day basis.
Epidural steroid injections are commonly used to treat sciatica, often without success. To relieve inflammation, a high concentration of the steroid (an anti-inflammatory) must reach the inflamed nerve root. When a simple epidural is performed, the medicine may not get close enough to the irritated nerve root.
For this reason, skilled pain management physicians now perform transforaminal epidural steroid injections.
This technique places concentrated doses of steroid next to the irritated nerves. It involves testing several exiting nerve roots to see which one is affected. Once the offending nerve root is detected, steroid is administered to “turn off” the pain. This highly selective epidural ensures that the medicine reaches the affected nerve root in high concentrations.
Other sciatic conditions can also be treated successfully with transforaminal epidural injections. This technique is often used to treat sciatica in patients who have had previous surgery and still have leg pain or when their leg pain recurs after some time.
In addition, patients with spinal stenosis often experience persistent leg pain, resulting from nerve root irritation that occurs as the spine degenerates. Medical studies have shown that the leg pain associated with spinal stenosis can be treated successfully with transforaminal epidural injections.
Treatment success is maximized when transforaminal epidural steroid injections are performed under x-ray guidance (fluoroscopy). This allows the physician to guide the path of the needle, which ensures the medicine reaches the precise location of the affected nerve.
In some cases, a disc protrusion, bulge, or herniation may be completely unresponsive to epidural injections. In these cases, percutaneous disc decompression may be performed to resolve recurring sciatic pain. This nonsurgical technique removes about ten percent of the disc through a needle while the patient is comfortably sedated.
Transforaminal epidurals and percutaneous disc decompression have revolutionized pain management. These advanced techniques have allowed skilled pain management physicians to help many sciatica patients avoid the need for surgery and life a relatively pain-free life.
We find that many sciatica sufferers are unaware that nonsurgical options are available that can resolve their discomfort for months, or even years. To learn more or for an assessment for yourself or someone you know, call Advanced Pain Management & Spine Specialists (APMSS) at 239-437-8000.
You’ll begin by seeing one of our Board Certified Physicians, each of whom is highly skilled and trained in modern pain medicine. Ad APMSS, the very latest techniques and technology are utilized, with patient comfort always a priority.