WHAT IS SCIATICA?
If you suddenly start feeling pain in your lower back or hip that radiates to the back of your thigh and into your leg, you may be experiencing sciatica. Technically, sciatica isn’t a diagnosis; it’s a broad term describing pain along the sciatic nerve. Typical causes for sciatica include a herniated disc, spinal stenosis, a bone spur or arthritis.1
The sciatic nerve is a bundle of nerves that branches off from the spinal cord and runs from the buttocks down along the legs. You have two, one on each side of your body. Sciatica can affect any area along the sciatic nerve.2
WHO IS LIKELY TO HAVE SCIATICA?
Most people develop sciatica between the ages of 30 and 50. It may result from the general wear and tear of aging (arthritis) or any sudden pressure on the disks that cushion the bones (vertebrae) of the lower spine.
Other risk factors for sciatica include obesity, diabetes or prolonged sitting. People in jobs that require twisting the back, carrying heavy loads or driving a motor vehicle for long periods are also prone to sciatica.3
WHAT ARE THE SYMPTOMS OF SCIATICA?
Most patients describe sciatica pain as a burning, or an electric shock, which shoots or radiates down the leg on the affected side. Coughing, sneezing, bending or lifting your legs may trigger or exacerbate the pain. In severe cases, sciatica may cause muscle weakness or even incontinence. Patients may also experience tingling, a "pins and needles" sensation, numbness, or a burning sensation down the leg. Usually, sciatica affects only one side of the body.4
Diagnosis for sciatica begins with a complete patient history and a physical exam. Your doctor may ask you to squat and rise, walk on your heels and toes, raise your leg or do other tests. X-rays and other specialized imaging tools, such as a magnetic resonance imaging (MRI) scan, may confirm your doctor's diagnosis of which nerve roots are affected.5
WHAT ARE THE TREATMENTS FOR SCIATICA?
Thankfully, sciatica heals itself within several weeks for approximately 80 to 90% of patients. However, if the pain lasts more than three months, and is due to nerve compression caused by bone spurs, a herniated disk or spinal stenosis, surgery might be recommended.
If you do need surgery for sciatica, endoscopic spine surgery may offer an option for relief that’s minimally invasive.
WHAT IS ENDOSCOPIC SPINE SURGERY?
Endoscopic spine surgery is a surgical technique used to remove pressure from spinal nerves. During ESS, the surgeon views the spine through a narrow camera (called an endoscope) placed through an incision less than a centimeter in length. Specialized instruments are then inserted through the endoscope and used to remove herniated discs, bone spurs, and other causes of spinal stenosis. Traditional spine surgery can also treat these conditions; however, endoscopic spine surgery is the least invasive surgical technique.
WHO IS A CANDIDATE FOR ENDOSCOPIC SPINE SURGERY?
Most people who have sciatica or other spinal conditions will be able to manage them without surgery. Still, in some cases, your doctor may recommend spine surgery if your pain has been relieved by conservative efforts such as medication, lifestyle changes or injections. Spine surgery should be reserved as a last resort after all other treatment options have been considered. Endoscopic spine surgery can address herniated or bulging discs, spinal stenosis or compressed nerves in the spine that can cause sciatica pain, numbness, and or weakness in the extremities (i.e., arms or legs). ESS can be utilized in the neck or back.
HOW IS ENDOSCOPIC SPINE SURGERY PERFORMED?
During an endoscopic procedure, the spine surgeon makes a small incision through which several dilating tubes are placed to temporarily spread the tissues apart. A hollow tubular retractor approximately the diameter of a pencil is then inserted over the dilators and wire, which are then removed.
A small camera with a built-in light source is placed through the tubular retractor. The spine and other tissues are viewed by the surgeon on a high-definition display monitor. Surgical instruments, simultaneously placed through the same tube, can then be used to remove any pressure from the affected nerve(s). This may involve resection of herniated disc material and/or bone spurs. By the end of the procedure, all sources of nerve compression are eliminated.
The camera, instruments, and tubular retractor are then removed, and the muscles and other soft tissues return to their normal positions. A stitch beneath the skin and a small bandage is all that is needed over the site of the surgery.
RECOVERY AFTER ENDOSCOPIC SPINE SURGERY
Endoscopic spine surgery typically takes about an hour to perform. Most patients are discharged to go home within a couple of hours after the surgery.
“Patients go home the day of surgery,” Dr. Peter Derman, M.D., an endoscopic spine surgeon on the medical staff said. “Very little pain medication is necessary; in fact, I often have patients who just take Tylenol or even nothing after the procedure. Patients can be active as soon as they feel comfortable doing so, even on the day of surgery. Walking, stationary bike, and other low-impact activities are good options in the days and weeks after surgery. I had one patient recently who told me she was at the gym on the elliptical less than 24 hours after her spine surgery, which is pretty incredible.”
BENEFITS OF ENDOSCOPIC SPINE SURGERY
Some of the reasons why you should choose endoscopic spine surgery for sciatica include:
• Outpatient procedure
• Shorter recovery time and quicker return to daily activities, including work and play
• Small incision (less than a centimeter)
• Less postoperative pain and pain medications
• Local anesthesia with sedation, rather than general anesthesia, may be used
• Minimal blood loss during surgery
• Reduced risk of infection
• Avoid fusion in certain circumstances in which it would otherwise be necessary
ENDOSCOPIC SPINE SURGERY IN TEXAS
Texas Health Center for Diagnostics & Surgery is an award-winning surgical hospital. If you are suffering from sciatica and want to know if endoscopic spine surgery is right for you, take our online assessment to see if you could be a candidate.
[1] “Sciatica.” Ortho Info website from the American Academy of Orthopaedic Surgeons
[2] https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435
[3] Sciatica, Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/12792-sciatica
[4] Sciatica, Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/12792-sciatica
[5] https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435