Sciatica, also known as lumbar sciatica, is commonly known as sciatica. Acute or subacute pain radiating from the lower back down the legs. A disorder involving radiculopathy caused by damage to the lumbar nerve roots, in which L5 and S1 are most commonly affected.
he Dr. Juan Fernando García Henares, Head of Pain Department Quirónsalud from Alicante, explains The sciatic nerve originates from the spinal cord from spinal nerve roots L4, L5, S1, S2, and S3, which emerge from the spine in the lumbar and sacral regions.
These roots join together to form the sciatic nerve in the hip area. for this reason, When they become irritated or compressed, they can trigger symptoms of sciatica, or lumbar sciatica. When something compresses or irritates this nerve, it can cause pain in the lower back and one or both legs.
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From that point on, several possible injuries can occur for different reasons. on the one hand, herniated disc: One of the leading causes of sciatica is a herniated disc, which occurs when a disc herniates or ruptures, putting pressure on the nerve root.
in addition, spinal stenosis, because as we age, the spine may develop a narrowing of the spinal canal, called spinal stenosis. And this compression affects the origin of the sciatic nerve.
Other forms of sciatica start with Spinal cord injurydue to spinal trauma or tumors that can compress the sciatic nerve and damage the spine.
In addition, Dr. also cited Piriformis syndrome: If the piriformis muscle becomes inflamed or overly tight, it can irritate the sciatic nerve, producing what is known as pseudosciatica (deep glute syndrome).
Finally, during this period Pregnancy, weight gain, and body changes They put pressure on the sciatic nerve, causing sciatica in some women. In fact, being overweight and physically inactive can increase your risk of low back pain by putting additional stress on your spine.
All in all, sciatica can also Degenerative diseases caused by: As we age, the spine often undergoes degenerative changes, such as osteoarthritis, which may lead to the development of lumbar sciatica.
Fernández Henares guarantees sciatica always occurs in the lower limbs (Legs) Because a similar condition in the upper limbs is called cervicobrachial pain. This condition does not affect the lower back and legs but instead involves the neck and arms, known as cervical radiculopathy. Due to the complexity of the cervical spine, treatment of this condition often requires more specialization.
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How to treat?
Symptoms of sciatica can vary, but most commonly include pain: Stinging, burning, or persistent pain that radiates from the lower back down the legs. Additionally, paresthesia, or abnormal sensations such as tingling, numbness, or muscle weakness, may occur in the affected leg.
In addition, pain often occurs The condition tends to worsen while sitting When sitting for long periods of time. Or there is a loss of muscle strength, which may make it difficult to move the affected leg or lift heavy objects.
he The director of the pain department at Quirónsalud in Alicante supports conservative treatment. “For most people with a herniated disc, treatment begins conservatively. Because as high as 90% will be reabsorbed spontaneously”.”
“This includes Rest, medications to treat pain and inflammation, and physical therapy Strengthen muscles and improve mobility. The medical approach to treating this kind of pain must address the root cause of the pain, which is mainly neuropathic, through the use of specific drugs or adjuvants,” the doctor recalled.
However, according to García Henares, Sometimes another minimally invasive treatment is needed. These percutaneous disc herniation treatments are minimally invasive medical procedures designed to relieve the pain and symptoms caused by a herniated disc without the need for open surgery.
These procedures are done through small incisions in the skin There are usually fewer complications and shorter recovery time than traditional surgery.
“All of our treatments are done in a minimally invasive manner. That is, outpatient and percutaneous treatments. The procedures we perform include Epidural injection. Therefore, drugs are injected directly into the epidural space, usually corticosteroids along with a local anesthetic, and in other cases ozone or platelet-rich plasma (PRP).
Such drugs in this area help Reduce inflammation and relieve pain. This is a very effective symptomatic treatment in some cases and allows the patient to return to the gym to readjust.
Another program is based on Nerve root or dorsal root ganglion (DRG) infiltration. With this surgery, you will try to find the nerve root causing your sciatica, as it is often irritated or compressed by a herniated disc. Once positioned, a precise injection of corticosteroids, local anesthetic, or PRP is administered, often in conjunction with neuromodulation treatments such as pulsed radiofrequency.
Quirón Salud Alicante also practices Nucleoplasty or percutaneous disc decompression. This is a minimally invasive technique suitable for patients with herniated discs and lumbar spine or nerve root pain. Once the needle is precisely placed on the disc, the damage is done using different types of energy, such as radiofrequency, with the goal of reducing pressure and reducing the patient’s pain by changing the collagen of the annulus fibrosus and ablating pain receptors. Here we include IDET (Intradiscal Electrothermal Therapy) and Dioplasty (Bipolar Intradiscal Radiofrequency Therapy).
The pain department also offers Intradiscal regenerative medicine. Injections of stem cells (MSC) and PRP are a minimally invasive method of relieving disc pain. “Regenerative therapies have been shown to improve water content, disc height and increase cell proliferation due to growth factors and cytokines such as PDGF, IGF-1, TGF-β and VEGF. They have also been shown to have local anti-inflammatory and antibacterial properties. and bactericidal proteins,” recalls Dr. García Henares.
Quirónsalud’s service portfolio includes Intradiscal ozone therapy. The technique involves injecting a mixture of oxygen and ozone directly into the herniated disc. Ozone is thought to reduce inflammation and stimulate tissue regeneration, thereby relieving pain and improving function.
All in all, another option is Transcutaneous laser treatment. During this procedure, different wavelengths of laser light, appropriate for each situation, are used to vaporize or decompress the herniated disc tissue. It is performed through small incisions and recovery times are usually faster than open surgery.
What is the success rate for each?
“Our pain department focuses on minimally invasive treatments, mainly regenerative medicine. We mentioned one of its advantages Its potential anti-inflammatory ability and its adverse effects are minimal Because it is obtained from the same patient and preserves the structure of the disc and the biomechanical stability of that anatomical part,” the doctor said.
“These treatments have similar success rates to open surgery (80-90%) but with fewer potential complications. Literature supports the effectiveness of these techniqueswhich can significantly relieve patients’ pain and improve their quality of life through outpatient surgery,” he added.
“Each case is assessed individually, These methods should be given priority before considering open surgery, which carries greater risks and longer recovery times. ” concluded García Henares.