Lumbar Radiculopathy (“Sciatica”) and Herniated Disc

Lumbar radiculopathy/sciatica is term used to describe radiating leg pain, tingling, numbness, or weakness caused by inflammation or compression of a spinal nerve in the lower back. Lumbar radiculopathy can result from a Degenerated disc,herniated disc, Spondylolisthesis or spinal canal stenosis (narrowing of the lumbar spine).

Herniated Disc

• Tear in the outer wall (annulus) of the disc allows the inner gel (nucleus) to protrude into the spinal canal

Natural History (“Doing Nothing”)

• Not all degenerated discs are symptomatic
• Symptoms may resolve with rest and conservative treatment of 2-3 weeks.
• Herniated material may get shrink over time.

“Cauda Equina Syndrome”

• Emergency 
• Loss of bowel and bladder function, weakness or perianal numbness due to pressure an all of the nerves running through the spinal canal
• Caused by large herniated disc
• Surgical treatment needed urgently

Three Phases of Treatment for Lumbar Disc Herniation:

• Phase I – Non-Invasive Treatments
• Phase II – Interventional Pain management/ Spine injections
• Phase III – Surgery (Endoscopy/MIS)
• Goals of Each Phase:
• Relieve Pain
• Improve Function

Treatment Options for Lumbar Disc Herniation: Phase I

• Rest
• Oral Medications
• Steroids
• Non-Steroid Anti-Inflammatories (NSAIDs)
• Physical Therapy and Home Exercise
• Ice and Heat

Treatment Options for Lumbar Disc Herniation: Phase II

• Epidural Steroid Injections
• Day care procedure
• Done with x-ray guidance

Treatment Options for Lumbar Disc Herniation: Phase III – Surgery

1)Transforaminal Endoscopic Lumbar Dissectomy

2) Interlaminar Endocopic Lumbar Dissectomy

3) MicroLumbar Dissectomy