Sciatica is a condition that occurs when nerve roots are compressed or irritated in the area of the spine located in the lower back. This condition is also called lumbar radiculopathy. Lumbar refers to the area of the spine in which it occurs, while radiculopathy is the word used to describe pain, weakness, tingling and numbness caused by irritation of the nerve roots. The human spine or back is composed of a complex arrangement of bones, discs, muscles, ligaments and tendons. Each block of bone or vertebrae is separated by a cartlage like structure called a disk. Problems with any of these structures may lead to low back pain. Occasionally the causes of back pain is never found. The following are some of the most common causes of low back pain: strain – muscles or ligaments structural problems herniated or bulging discs sciatica arthritis abnormal curvature osteoporosis cauda equina syndrome cancer of the spine infection of the spine shingles bed mattress sleeping disorder every day activities or poor posture Dr.Sandeep C Agrawal Consultant Orthopaedic Surgeon Joint replacement & Spinal surgeon Complex Trauma Fracture & Revision Surgery Expert Agrasen Hospital Gondia Vidarbha Maharashtra India www.drsandeepagrawal.com www.agrasenortho.com

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Dr.Sandeep Agrawal
Consultant Orthopedic Surgeon
MS,DNB
Agrasen Hospital
Gondia
Maharashtra
India
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www.drsandeepagrawal.com
drsandeep123@gmail.com
09960122234
EXPLORING SCIATICA (BACK PAIN )
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17. • Conservative treatment
– Alters the natural history ?
• Foraminal epidural steroid injection
– Positive response: more than 50% leg pain
improvement
– 3 to 4 times in one year
• Absolute indication for surgery
– Bladder and bowel symptoms
– Progressive neurologic deficit
• Relative indication for surgery
– Intractable pain more than 6 weeks
• Three sciatica episodes -> 100% future episodes
• Gold standard: laminotomy + discectomy
• Extraforaminal disc: Wiltse paraspinal approach

18. • Bed Rest (80% resolution within 6 weeks),
herniated disc reduced in size over time
( water content loss, inflammatory
cytokines reduction)
• Medication
• Activity modification
• Steroid injection => improved symptoms
• Chymopapain –Possible anaphylatic shock
Lyman Smith, 1963

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