What is sciatica?
Sciatica is pain in leg due to compression of sciatic nerve, which travels behind the hip joint into the leg. Sciatica is commonly caused by disc prolapse between 4th and 5th lumbar vertebrae and 5th lumbar and 1st sacral vertebra.
Does disc prolapse occur in old age?
Disc prolapse is usually seen in young and middle aged patients. Intervertebral discs start degenerating early in life and can prolapse in adolescents as well.
What symptoms occur in prolapse lumbar intervertebral disc?
Patients present with sudden onset of leg pain usually following lifting weight or a bout of sneeze. The pain may be associated with tingling sensation or numbness in leg.
How long is bed rest recommended following prolapsed lumbar intervertebral disc?
Bed rest is recommended only for 48-72 hours following acute attack of prolapsed lumbar intervertebral disc. Early exercises and mobilization within limits of pain tolerance is recommended.
Is traction useful in prolapsed lumbar intervertebral disc?
Traction, short wave diathermy, prolonged bed rest have not shown to be effective in treatment of prolapsed lumbar intervertebral disc.
Are there any other procedures, which are useful before considering surgery?
Nerve root blocks and epidural injections may help to alleviate pain. These procedures may be considered in selected cases before considering discectomy.
Is surgery always necessary in prolapse inetrvertebral disc?
90% of patients with prolapse lumbar intervertebral disc respond to non-operative treatment. Only few patients whose pain does not respond or in those whose weakness progress will need surgical treatment
When is surgery urgently recommended in prolapsed lumbar intervertebral disc?
In some patients a large disc prolapse causes significant compression of nerves supplying lower limbs and bladder and bowel. Such patients present with severe bilateral leg pain with loss of sensations and weakness both lower limbs. They also lose control of bladder and bowel function. This is called cauda equina syndrome and urgent surgery is recommended in such situation.