What are the options for sciatica?
Your back is made up of vertebrae, disks and nerves going to you legs. The vertebrae are made up of vertebral body in the front and lamina and spinal process in the back. The spinal cord and spinal nerves are located in-between. If the disks in the back slip out of position and pinch the nerves going to the legs the brain registers this as leg pain even though the problem is in your back. Sciatica is back and pain typically caused by a herniated disk compressing one of the spinal nerves that become part of the sciatic nerve. The most common surgery for sciatica is discectomy, or removal of the piece of disk pinching the nerve. Discectomy procedures include:
1. Laminotomy and discectomy- surgeon makes a midline skin in the lower back. The back muscles are divided and retracted to the side. The protective bony lamina is removed to reveal the nerve sac (theca sac) and spinal nerves. The spinal nerves and nerve sac are retracted and the disk herniation is identified and removed. This is sometimes called a traditional, open discectomy.
2. Miscroscopic discectomy – Same as laminotomy and discectomy but a microscope is used. The microscopic does not indicate smaller incision but the use of microscope to improve light and visualization.
3. Tubular microscopic discectomy- Same as microscopic discectomy but instead of making a large skin incision and muscle retraction the surgery is done through a tube. The skin and muscles are dilated. Spine bone is removed in a similar fashion to #1 and #2. Common tube sizes range from 18 to 27 mm in size. This technique decreases muscle damage and likely back weakness and pain long term.
4. Endoscopic discectomy– This is a revolutionary new procedure. A very small 8 mm tube is placed into the spine through an existing hole called a foramen. The hole can even be enlarged if needed. After the tube is in place, a very small high definition video camera is placed through the tube into the spine. The disk can be found and removed with tiny instruments quickly relieving pain and suffering. Patients are discharge home right after the procedure and usually experience less postoperative pain. Many people do not take pain medicine after surgery. As you can see spinal disk surgery has come a long way.
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