The term sciatica, slipped disc, disc bulge is commonly used to describe such a condition. It is a common, and fortunately the majority do get better in six to twelve weeks with appropriate management. Patients often describe their sciatic nerve is trapped and causing shooting leg pain, which is not the case. The sciatic nerve is a thick cord-like nerve formed by the joining of several nerves (Cars from Motorway) coming together (Read Spinal Motorways). As described earlier, the car trapped in the slip road of the motorway tends to produce the classical radicular shooting leg pain.
The majority of the patients present with leg pain symptoms which are shooting in nature as described earlier (About Spine Symptoms). However, some will have both back and leg pain symptoms due to wear related changes in the disc. These symptoms can be aggravated by coughing and sneezing.
MRI scan of lumbar spine illustrating disc prolapse from the side and top.
The normal disc (outlined in blue) maintains it height and the prolapsed disc (outlined in red) has bulged into the canal or the superhighway. In the motorway’s view the car (yellow outlined) appears to be pushed against the hard shoulder by the bulging disc.
You may ask “Are these symptoms worrying?”
The majority of these symptoms do get better with appropriate painkillers and physiotherapy. The goal of any treatment at the early stage is to control pain and avoid any progressive neurological damage (i.e. weakness). This is initially achieved with appropriate painkillers and targeted physiotherapy. Other forms of alternative medicine like yoga, Pilates, acupuncture and chiropractic therapy can also be explored.
You may also ask “How long do we need to continue with non-operative option?”
This is a very important question and needs to be discussed individually. In general, any management plan needs to be weighed against the potential risk associated with it. My thought on this is to take minimum risk to achieve maximum benefit. This can vary with individuals and would need to be tailored according to an individual patient’s goal. I would suggest you discuss this with your treating clinician and make an informed decision to take things forward. However, we have to remember if these symptoms are not addressed for long period, it can become chronic pain.
The following conditions will need discussion regarding surgery.
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Cauda Equina Syndrome (Read Below)
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Weakness
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Failure of conservative approach to manage pain
In these situations, a further management plan needs to be discussed to help your condition. The option can vary depending on the urgency and nature of pain.
They may include:
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Steroid Injection – Under image guidance (commonly X-ray) a mixture of local anaesthesia and steroid is injected around the nerve root. This helps with the leg pain by damping the inflammatory process and is done as day case procedure. (Read More)
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Microdiscectomy – In simple terms, the motorway is cleared by shaving the disc for the nerve to flow freely. This procedure is performed under general anaesthesia as a same day or overnight stay procedure. (Read More)
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Endoscopic (Keyhole) Surgery – This is performed with less than 1 cm stab wound using high end technology similar to that used in knee and shoulder. Due to minimally invasive approach it helps in early recovery. (Read More)
There are other conditions which can mimic radicular leg pain, such as the hip, knee and ankle (Read about referred pain), problems with blood supply to the leg, Sacroilliac joint pain, peripheral nerve problems and so on. Therefore, it is important to seek medical advice to identify cause of these symptoms.
Cauda Equina Syndrome
Cauda equina syndrome is a rare condition, but considered as surgical emergency. Being a syndrome, it consists of combination of symptoms, including from back pain, leg pain, weakness and bladder/bowel symptoms. The bladder/bowel symptoms present in form of numbness around the private parts/bottom, urinary and bowel incontinence (Inability to control your water works and bowel).
The problem lies in the motorway, whereby a large disc fragment has obstructed the whole of the carriageway. This leads to damage of the nerves supplying bladder and bowel.
The outcome following the surgery is thought to be time dependent, or in simple terms, the sooner the better. Thus, these symptoms should be taken as a matter of urgency and immediate medical attention is needed.
MRI scan of lumbar spine illustrating disc prolapse causing Cauda Equina Syndrome.
The normal disc (outlined in blue) maintains it height and the prolapsed disc (outlined in red) has bulged into the canal or the superhighway. The motorway is completely occluded to damage the nerves.