Sciatica/ Disc Herniation
The human spine is composed of multiple bones (vertebrae) which are interconnected by disco-ligamentous structure called intervertebral disc or simply called as “disc”.
There are 23 discs in a human spine, which help in smooth motion of the vertebrae, thereby giving the flexibility to your spine. Like gel cushion, they absorb pressure and impact.
When small tears occur in the outer layers of the disc, the gel-like central core of disc can protrude into fibrous layer (disc protrusion/bulge) or break through the fibrous layer (disc prolapse/extrusion/herniation). This extruded disc material, by chemical or physical properties, can irritate the nerves at that level innervating upper or lower limbs. Depending on the region of disc herniation it is called lumbar (lower back spine) or cervical (neck) disc herniation.
What are risk factors for developing disc herniation?
Often there is no definite cause for one to have disc herniation. However, it is due to an acute event in the presence of long-standing risk factors in a predisposed individual or a result of exaggerated normal wear and tear and degeneration.
Predisposed individuals (risk factors)
Are you suffering from this problem
The symptoms vary depending on the location and severity of the herniated disc.
Clinical examination will give a fair idea of what the problem could be, and to confirm the diagnosis you may asked to get an X-ray or MRI of the involved region. MRI can delineate exactly at what level disc is herniated and how much it compresses the nerve root involved. However, a study revealed that more than 50% of people with disc herniation don’t have any symptoms. Hence, we don’t recommend getting an MRI done unless you have specific symptoms and signs.
Prognosis: 90% of patients will get relief from the symptoms by conservative management. Only 5-10 % may require surgical management.
Transforaminal Epidural Steroid Injections (TESI)
A few patients, who do not get relief with conservative therapy, may require TESI.
This is the standard treatment for lumbar disc herniation and has highest success rate, besides being the least complicated.
Usually (90-95%), patients will be able to walk on the same day or the next day. They will be fit to go home in 24-48 hours and resume light activities within 15 days. In 5 -10 % of the patients, there may not be complete relief in symptoms. In 1-5 % of patients, there might be minor complications like CSF leak, in which case walking is delayed for 48 hours, and risk of local infection and recurrence.