Sciatica / Pinched Nerve Treatments

Radiculopathy, which occurs when a nerve root in the spine is compressed or irritated, often leads to symptoms like pain, numbness, tingling, and weakness that radiate along the nerve path. The treatment for radiculopathy typically depends on the severity and cause of the nerve compression. Here are the most common treatments for radiculopathy:

Physical Therapy

• Strengthening exercises: Physical therapy can help strengthen the muscles surrounding the affected nerve root, which can alleviate pressure on the nerve.
• Posture correction: Improving posture and spinal alignment can help reduce nerve compression.
• Stretching exercises: Gentle stretches may help improve flexibility and reduce nerve tension, particularly in the back, neck, and legs.
• Manual therapy: Some therapists use hands-on techniques to manipulate the spine and relieve pressure on the nerve.

Cold and Heat Therapy

• Ice can be applied during the acute phase to reduce inflammation and numb the pain.
• Heat therapy can help relax tight muscles and improve blood flow after the initial inflammation has subsided.

Chiropractic Care

• Spinal manipulation (also known as chiropractic adjustments) can be used to address spinal misalignment and improve mobility. While chiropractic care is effective for some people with radiculopathy, it may not be suitable for everyone, especially if there are serious underlying issues like fractures.

Medications

• Pain relievers: Over-the-counter medications such as NSAIDs (ibuprofen or naproxen) can help reduce inflammation and manage pain.
• Acetaminophen: An alternative to NSAIDs, useful for mild pain relief.
• Muscle relaxants: These may be prescribed if muscle spasms are present, helping to relax the muscles surrounding the affected nerve.
• Corticosteroids: Oral corticosteroids (prednisone) may be prescribed for short-term use to reduce inflammation around the nerve.
• Antidepressants or Anticonvulsants: These are sometimes used to treat nerve pain (neuropathic pain) by altering nerve signaling. Tricyclic antidepressants (like amitriptyline) or gabapentin and pregabalin (anticonvulsants) can help with nerve-related pain.

Spinal Injections (Epidural Steroid Injections)

• Epidural steroid injections are a common treatment for radiculopathy, especially when pain is severe and does not improve with oral medications.
• The injection delivers steroids directly into the epidural space around the affected nerve to reduce inflammation and provide pain relief. This can last for weeks to months and helps patients manage pain long enough to engage in physical therapy.

How it Works:

• Diagnosis and Preparation:
  • A diagnostic evaluation is done to determine if a herniated disc is the cause of the patient’s symptoms. This may include imaging tests like MRI or CT scans.
  • The patient is typically given a local anesthetic to numb the treatment area and may receive sedation for comfort.
• Procedure:
  • The procedure is performed through a small incision, usually less than a centimeter in length. A needle or catheter is inserted through the skin and guided to the site of the herniated disc using fluoroscopy (real-time X-ray imaging).
  • Once the needle or catheter is in place, laser or radiofrequency energy is often used to vaporize or remove the portion of the disc that is protruding and causing pressure on the nerves. In some cases, a small mechanical device might be used to remove the disc material.
• Effect: The goal is to remove enough of the disc material to relieve pressure on the affected nerve, which can significantly reduce or eliminate pain, numbness, or weakness caused by the herniated disc.

Percutaneous Endoscopic Discectomy

Percutaneous endoscopic discectomy is a minimally invasive surgical procedure used to treat certain types of herniated discs in the spine. It is designed to remove or reduce the part of the disc that is pressing on the surrounding nerves, which is often the cause of pain, numbness, or weakness in the back, neck, or limbs.

Benefits of :

• Minimally Invasive: Unlike traditional open surgery, percutaneous discectomy requires only a small incision, leading to less tissue disruption, smaller scars, and quicker recovery.
• Outpatient Procedure: It is typically performed on an outpatient basis, meaning you can go home the same day.
• Faster Recovery: Most patients experience a quicker recovery compared to traditional discectomy (open surgery), with many returning to normal activities within a few weeks.
• Reduced Risk of Complications: Because the procedure is minimally invasive, the risk of infection, bleeding, and other complications is generally lower than with traditional surgery.

Ideal Candidates:

Percutaneous discectomy is typically recommended for patients who have a herniated disc in the lumbar (lower back) or cervical (neck) spine and have not found relief through non-surgical treatments (such as physical therapy, medications, or epidural steroid injections). It is most effective for smaller herniations that are causing nerve compression and symptoms like sciatica (pain radiating down the leg) or radiculopathy (nerve root pain).

Surgery is typically considered only when conservative treatments do not provide relief, or if the patient has severe nerve compression causing significant weakness, loss of function, or other complications. Surgical options include: