spine

Sciatica

sciatica

Sciatica is derived from Medieval Latin, specifically the word sciaticus =hip, or from the Greek word iskhiadikos=hip. Although sciatica is a relatively common form of low back pain and leg pain, the true meaning of the term is often misunderstood. Sciatica is actually a set of symptoms including pain that may be caused by general compression and/or irritation of one of five nerve roots that give rise to the sciatic nerve, or by compression or irritation of the sciatic nerve itself. The pain is felt in the lower back, buttock, and/or various parts of the leg and foot. In addition to pain, which is sometimes severe, there may be numbness, muscular weakness, and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body. This point is important, because treatment for sciatica or sciatic symptoms will often be different, depending upon the underlying cause of the symptoms. Sciatica is actually a set of symptoms including pain that may be caused by general compression and/or irritation of one of five lumbar nerve roots that give rise to the sciatic nerve, or by compression or irritation of the sciatic nerve itself. The pain is felt in the lower back, buttock, and/or various parts of the leg and foot.

sciatica

Sciatica often starts with the dehydration of the disc material. This can start as early as your late twenties. The discs typically work as the shock absorbers of the spine. As a result of their dehydration there is an overall loss of disc height and function which places more stress on the already weakened disc material.

Dehydration and Degeneration of the Disc

sciatica

Eventually, this stress can cause an outward bulging of the disc into the spinal canal. Occasionally, the disc material can even rupture through the outer layer of the disc into the spinal canal. Lumbar disc herniation is characterized by a bulge or rupture of the disc material into the spinal canal, which can cause abnormal pressure on the nerve at that level, leading to symptoms in the back and one leg or foot.

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Symptoms

Sciatica can lead to chronic pain and stiffness in the lower back and buttocks that may radiate into to the lower legs, calves, feet or even toes. Patients may experience some or all of the following symptoms:

  • Lower Back pain (Which may be worse with upright activity)
  • Buttock pain
  • Back stiffness (Which may be worse with certain work activities)
  • Numbness in the thighs, calves, feet and toes
  • Weakness in the legs, thighs, calves, feet and toes
  • Trouble walking because of weakness in the legs or loss of balance
  • Grinding or popping sounds or sensations in the lower back
  • Muscle spasms (Which may originate from the back or lumbar paraspinal muscles)
  • Headaches
  • The condition can cause irritability, fatigue, and sleep disturbances
  • This may impair the ability to work or your daily activities.

Diagnosis

During your consultation, Dr. Pablo Pazmino will take a complete medical history to rule out other conditions that can cause symptoms similar to Lumbar Spinal Stenosis. Dr. Pablo Pazmino will also perform a complete and thorough physical examination. Radiography (X-rays) and other diagnostic imaging tests (MRIs, EMGs, CAT scans) will then be reviewed so that Dr. Pablo Pazmino can evaluate your bony quality, any neural compression, bone spurs and other abnormalities to reveal the extent of damage to the lumbar spine.

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Education

At Santa Monica Spine / Beverly Spine we pride ourselves in our duty to educate our patients. Dr. Pablo Pazmino uses his background as a former teacher to ensure that you understand your pathology, imaging (X-rays and MRI) and treatment options completely during each visit. Our patients often comment they are amazed at the amount of time and effort we take to review their studies. Many have never had this experience before and feel like they are a true part of the decision making process. We want our patients to be involved in every step of the process and we feel education is the first step towards achieving that goal together.

Medical History

At Santa Monica Spine / Beverly Spine we are very thorough. Dr. Pablo Pazmino will need a complete history of any medical illnesses, surgeries, or chronic conditions which you may have or for which you have seen other physicians in the past.

More specifically we will require a history of your back and leg pain itself. What is the exact location of the pain? When did the problem begin? What does the pain feel like? Has your back been injured before? Have you previously been treated for back or leg pain?

Nonsurgical Treatment

Symptoms of Lumbar degenerative discs, herniations, or slipped discs may last for several months or become chronic. Most patients with Lumbar degenerative discs, herniations, or slipped discs or Radiculopathy can be treated non-operatively. Dr. Pablo Pazmino may recommend a course of physician guided conservative management.

  • Rest. A short course of bed rest or a brace may be used to limit painful lumbar motion and relieve irritation.
  • Medication. Dr. Pablo Pazmino may prescribe nonsteroidal anti-inflammatory medications (NSAIDs) or other non-narcotic pain relievers to relieve your pain and reduce swelling.
  • Acupuncture. Dr. Pablo Pazmino works with a team of Acupuncture specialists and may recommend this if indicated for your specific set of symptoms.
  • Chiropractic Management. Dr. Pablo Pazmino works with a reliable team of Chiropractors and may recommend this if indicated for your symptoms.
  • Physical therapy. A course of therapy guided by Dr. Pablo Pazmino may include hot and cold therapy, ultrasound or an active exercise program which may help relieve symptoms. Exercises may include core body strengthening, lumbar and lower extremity stretching, and aerobic exercises. Patients may also receive gentle massage and perform activities to improve posture.
  • Injections: A series of selective nerve root blocks or epidural injections of a cortisone-like drug may lessen nerve irritation and allow more effective participation in physical therapy. These injections are given on an outpatient basis over a period of weeks. Dr. Pablo Pazmino only works with a small group of physicians who he trusts to perform these injections. Click here to see some of the recommendations Dr. Pablo Pazmino makes in regards to injections and pain management physicians.

Nonsurgical treatment may take away most of the symptoms, but it does not treat the underlying structural cause. Follow-up visits are necessary so Dr. Pablo Pazmino can check if symptoms have gotten better, worse, or have stayed the same.

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Surgical Treatment

For some patients with significant pain and weakness, after failure of conservative management, Dr. Pablo Pazmino may recommend a surgical treatment option. The surgical treatment options may vary and depend on the individual patient and their pathology. Surgery may be necessary for patients with progressive neurologic symptoms or severe pain that does not improve with other treatments. Surgery may remove bone spurs or disc material (Decompression) and provide lasting pain relief.

In our practice, surgery is always reserved as a last option, but when necessary can have excellent results and often can improve your overall quality of life. If surgical treatment is warranted Dr. Pablo Pazmino can offer a variety of procedures for treating Lumbar disc herniations.

For more on surgical treatment options click the following powerpoint talks:

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Minimally Invasive Microdiscectomy

For patients with purely sciatica or radiculopathic pain at a vertebral segment Dr. Pablo Pazmino may recommend a minimally invasive microdiscectomy to decrease pain at this area. Removing a herniated fragment should decrease pain and symptoms generated from the degenerated herniated discs and any undue pressure. Upon successful decompression, the nerve can begin the healing process in its new environment and resume near anatomical function. Our patients can return to their activities of daily living.

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Lumbar Artificial Disc Replacement

For some patients with discogenic and sciatic pain at a vertebral segment Dr. Pablo Pazmino may recommend a Lumbar Artificial Disc Replacement, or Lumbar Arthroplasty, to decrease pain at this area. Immobilizing painful movement in a specific area of the lumbar spine should decrease pain generated from the degenerated discs and compressed nerves. All lumbar arthroplasty require some bony ongrowth onto the metal endplates so the arthroplasty can become fully incorporated into the native spine. Upon successful incorporation, the vertebral segment can resume near anatomical motion, and patients can return to their activities of daily living.

When Should You Seek Medical Care?

If severe pain occurs following an injury (motor vehicle accident, diving accident, or fall), a trained professional, such as a paramedic, should immobilize you to avoid the risk of further injury and possible paralysis. Emergent medical care should be sought immediately.

Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs.

Radiating pain, or numbness in your arms or legs which causes weakness in the arms or legs without significant neck pain should also be evaluated.

If there has not been an injury, you should seek a Spinal Evaluation with Dr. Pablo Pazmino when pain is:

  1. Continuous and persistent
  2. Severe
  3. Accompanied by pain that radiates down the arms or legs
  4. Accompanied by headaches
  5. Accompanied by numbness, or tingling
  6. Accompanied by weakness!

Many patients seek care for Scoliosis pain by Dr. Pablo Pazmino because as an Orthopaedic surgeon he is specifically trained to diagnose, treat, and help prevent problems involving the muscles, bones, joints, ligaments, and tendons. Although Dr. Pablo Pazmino confines his practices to Spinal pathology he also treats a wide variety of diseases, injuries, and other conditions, including Spondylolisthesis.

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