SPINAL SURGERY

in Hull and East Yorkshire

GEORGE SPINK FRCS (Neurosurg.) BSc Hons

 

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SCIATICA

-      This common condition ('sciatica', 'slipped disc', 'prolapsed disc') is characterised by pain spreading from the lower back, through the buttock down the back of the leg into the calf or foot.

-      The pain is usually severe in the early stages and feels like an electric shock in the leg. It may be made worse by coughing or sneezing.

-      It is often associated with altered sensation or 'pins and needles' in the leg or foot.

-      Occasionally there may weakness of the affected leg or foot.

***If you develop severe pains in both legs, difficulty in passing urine, incontinence, or loss of sensation around your genitals, then you should contact your GP or A+E department as a matter of emergency***

-      The most common cause of sciatica is a prolapsed lumbar disc.  This occurs when the soft gelatinous centre of the disc ruptures backwards to squash the nerves in the back. This may require surgery (see lumbar microdiscectomy).

-      Other causes including 'wear and tear' degenerative disease in the joints and ligaments of the spine causing narrowing around the nerve roots. This may require surgery (see lumbar foramenotomy) or injection therapy (see nerve root blocks).

-      In addition to an outpatient assessment and examination you may require an MRI scan if your symptoms persist. (Most patients with a slipped disc will improve without surgery within 2-3 months). An MRI scan uses a powerful magnet to create a picture of your spine. It does not involve any radiation exposure. The scanner itself is a long narrow tunnel, which some patients may find a bit claustrophobic. It is also fairly noisy during the scan.

 

Treatments

-      Gentle exercise and simple analgesic (ibuprofen)

-      Nerve root blocks (highly selective x-ray technique)

-      Lumbar microdiscectomy (minimal invasive surgery)

-      Physiotherapy (gentle exercises manipulation should be used with caution)

 

Outcome

-      80 - 90% of patients improve following surgery, with the majority seeing complete resolution of their leg pain.

-      A few patients will have a technically successful operation but continue to have symptoms due to irreversible nerve injury.

-      A few patients also go onto develop scar tissue at the site of the operation, causing recurrent symptoms, which can be difficult to manage.