Is laser disc surgery safe?

Disc pathology occurs mainly in adulthood and can generate several degrees of pain that in some cases becomes disabling, having an important impact on the quality of life, both at the family and work levels. Due to this, it carries an economic cost for companies and for the public health system. The most frequent and characteristic radicular pain is that produced by the herniated discs that appear with greater frequency in the lumbar region. The treatment depends on the aetiology and there are different therapeutic options, from conservative to more or less invasive surgical interventions. Among the latter is nucleolysis or percutaneous disc decompression by laser (PLDD), which consists in the percutaneous approach of the intervertebral disc for performing the denaturation, by vaporization, of the nucleus pulposus using laser energy.

In the lumbar region pain reduction has been observed in 60-89% of patients operated by PLDD; however it is necessary to emphasize the high percentage of failure of the technique, which sometimes requires that up to 38% of successfully treated patients to be intervened again by conventional surgery. The failure due to the impossibility of performing the PLDD has been reported in several studies by 9%. In the cervical and thoracic location, an improvement of the symptoms is indicated between 54.5-83% at 24 months of follow-up. Although PLDD is a minimally invasive treatment, it does not mean that complications cannot emerge, studies of the lumbar region report the appearance of muscle spasm (7.7%), sacroiliac inflammation (4.5%), transient nerve root damage (5%), recurrences (1.5%) and discitis (1.2%). In addition, bleeding, bruising, new-onset root deficit and damage to the sigmoid artery have also been observed.

Caudal Epidural Technique

The technique consists of puncturing the sacrococcygeal hiatus to access the lumbar epidural space. The sacrococcygeal hiatus is an inverted V-shaped notch in the posterior wall of the sacral canal.

Placement of the patient in prone position on a stretcher and should stay 15-20 minutes after performing the technique under control.

What is a Nerve Root Block ?

A selective nerve lumbar nerve root block is a type of epidural steroid injection to treat lower back pain and sciatica caused by nerve root irritation .

What is the epidural space and what causes pain in that area?

Dura mater is a protective layer that covers the spinal cord and its nerves. The space that surrounds it is called the “epidural space”. In the lower back, it is known as lumbar epidural space.

The lumbar area of the dorsal medulla has 5 bones, called vertebrae. Between each one of them there are some soft discs that serve as protection, keep them together and control the movement. If a disc is torn, the chemical products that lie inside could get out causing inflammation of the dura mater and the nerve roots, which produces severe pain.

If you have pain in your lower back when you bend it, it may be due to an inflammation of the dura or lumbar discs, if the pain reaches your leg when you bend your back, it may be due to inflammation of the nerve root.

What is the selective nerve roots block?

In a lumbar epidural injection, an analgesic and a steroid are applied together directly in the epidural space to reduce inflammation. If the needle is placed next to an individual nerve root, the procedure is known as selective nerve root block. This technique involves introducing the medication directly along the inflamed nerve root. Fluoroscopy, a kind of X-ray procedure, can be used to ensure safe and proper needle placement.

The effectiveness of treatment depends on the degree of inflammation. Sometimes, the injection provides relief for several months, and then more doses are required. On other occasions, a single injection achieves long-term relief. If the cause of the pain is a lesion located in more than one area, an injection will eliminate only some of the symptoms

What is a Facet Joint Injection ?

Facet joint injection consists of placing a local anesthetic (medicine to numb an area) with a steroid (an anti-inflammatory medicine) in a facet joint of the dorsal column. The facet joints are located between the vertebrae. There are 2 facet joints between each pair of vertebrae. These joints give stability while allowing the spinal column to bend and turn. The use, wear, and old age can make these joints hurt a lot.

What is the purpose of this injection?

The goal is to relieve pain so you can return to perform your normal daily life activities unless your doctor tells you otherwise. In most cases, you can also do physiotherapy again.

What happens during the intervention?

The patient remains awake during the entire intervention. Blood pressure, heart rate, and breathing are continuously monitored. With the patient lying face down on the intervention table, the site of the injection is cleaned with an antiseptic. In this procedure, a needle passes through the skin, muscle and soft tissues, thus causing some discomfort for the patient.

A little anesthetic will be injected to numb the place where you are feeling pain. This intervention takes around 30 minutes.

What medicines are used in this intervention?

  • Lidocaine or bupivacaine are local anesthetics that are used to numb the site of the injection. Numbness usually disappears between 2 and 6 hours after the intervention.
  • Steroid medication such as Triamcinolone or depo-medrone is used commonly to treat inflammation and pain. The benefits of this steroid can take up to 10 days to appear.

Physiotherapy

Why are core muscles important for back pain?

Have you ever been told about the core muscles and its importance on back pain? In order to explain why this musculature is a determining factor in maintaining the stability and health of our back, it is necessary to understand the process; we will differentiate the muscles into two types:

-Mobilizers: Thanks to their characteristics, they have the main function of producing movement. An example can be the lumbar square also known as quadratus lumborum.

-Stabilizers: They have the main function of controlling the movement of the joints, giving them stability. Although there are also important shallower stabilizing muscles, these are the types of muscles commonly referred to when talking about deep musculature. An example is the multifiduss.

The origin of back pain

The functioning of the spine as a whole is not so simple, in spite of the division we make in stabilizing and mobilizing muscles, all the muscles have a stabilizing role. Following the previous examples the lumbar square also has insertions in the transverse processes of each vertebra which helps the stability of the spine despite the fact that its fundamental role is to perform movements. However, stabilization is not its main function as it is of the multifidus or other paravertebral muscles.

Sometimes when the stabilizing musculature is altered and is not able to meet its objective, the mobilizing muscles can supply this function. However, since they are not designed so that their main mission is stabilization, fatigue, muscular imbalances, contractures and, ultimately, back pain will occur.

The treatment and prevention of back pain will require a training program that affects the correct function of the stabilizing muscles.

What is the difference between physiotherapy and osteopathy?

The World Health Organization defines physiotherapy as the science of treatment by means of therapeutic exercise and physical agents (heat, cold, light, water, massage and electricity). It also includes the execution of electrical and manual tests to determine the value of affectation and muscular strength. Also tests to determine functional capacities, the amplitude of joint movement and measures of vital capacity. The physiotherapist has the ability to apply all these therapies. They do not only give massages but there are physiotherapists specializing in neurology, respiratory or cardiology systems, and never forgetting the musculoskeletal system, especially with therapeutic exercise.

Osteopathy is the medical science that treats the individual globally and holistically. In a diagnostic approach, they look for the cause and origin of the injury. It seeks and attends the zones of hypomobility, that is, areas that do not move correctly or that are blocked.

Its complete approach involves covering all the patient’s spheres (structural, cranial and visceral) with specific tests and techniques for diagnosis and treatment.

One of the clearest differences is the diagnostic method that is performed on the patient. In osteopathy, as we have said, a more holistic approach is taken. It seeks to integrate all areas of patient health. In physiotherapy, there is a greater focus on the area of ​​the lesion to look for the origin and above all in the causes of the locomotor system without taking into account the visceral and fluidic part of the patient.

We must also highlight the electrotherapy part of physiotherapy where different machines are used for diagnosis and treatment. However, osteopathy basically makes a diagnosis and manual treatment.

Another basic difference is the frequency between treatments. In physiotherapy and according to the pathology, sessions can be done daily. In osteopathy in almost no case sessions are made less than three days apart. It is normal to leave up to a week or ten days between sessions. This is due to the osteopathic principle of self-regulation of the body. Osteopaths seek to allow time for the body to recover with the help of our treatment.

5 ways to rapidly relieve sciatica

When the pain goes beyond the lower back and reaches the lower limbs, we talk about irradiated lumbar pain. If the pain extends from the lower back to the heel or foot, descending through the posterior or lateral thigh, we call it lumbosciatica (or simply sciatica). Its presence suggests lesion of the nerve roots that leave the lumbar spine and carry the sensitivity or orders to contract the muscles to the lower limbs through the sciatic nerve. If the pain does not go beyond the knee region, you should not talk about sciatica and its cause is not usually the injury of the nerve roots.

What can you do to relieve the pain?

1-First of all, take some rest, which should not last more than 2 days.

2-After this time, it is essential to begin to get up and to perform a smooth and progressive physical activity as you are noticing less pain.

3-In these phases, the application of local heat several times a day is useful.

4-Massage after the heat (especially if you notice that the muscles in the area are contracted) has demonstrated to be effective.

5-Take analgesics, such as paracetamol or metamizole, or nonsteroidal anti-inflammatory drugs.

In chronic low back pain, there are no big differences in the medications to be administered. In patients who also have an anxiety or depression component, some medication can be added to help relieve it. The regular practice of rehabilitation exercises and sports such as swimming are of great help for this ailment.

What warning signs tell you to go to see a specialist when you have back pain?

If adequate pain control is not achieved, the patient should consult a specialist in traumatology, since neuropathic pain usually causes great limitation and may require an adjustment of treatment.

In addition, if the alteration in the sensibility is maintained or progresses and, especially, if the weakness of the lower limb increases, secondary causes of lumbosciatica should be ruled out.

Also, if the non-surgical methods do not work, the patient can go to a spine or orthopedic surgeon.

Key signs to be concerned about ;

1. Severe back pain or sciatica that does not improve with medications or rest

2. Progressive numbness or weakness in legs or arms

3. Loss of sensation in bowels or bladder ie cannot cotrol urine flow or bowel movements

4. General feeling of being unwell or loss of appetite together with back pain

5. Fever associated with back or neck pain

6. Spinal deformity ie curvature with back or neck pain

7. Unexplained back pain in children or elderly

8. Back pain getting worse after surgery

9. Back pain or deformity after an injury

10. Back pain that is keeping youup or waking you up at night.

You should see a specialist that has experience in the full range of treatment options including therapy, medications, injections and surgery.

Sciatica in pregnancy

Several factors influence the onset of sciatica in pregnancy, including weight gain and postural changes to which the body is subjected throughout the gestation process.

It is a condition that, although it does not necessarily occur in all pregnant women, it is favored by some factors of pregnancy, such as weight gain, change in the body´s center of gravity, distension of the abdominal muscles and the action of hormones such as progesterone, which contributes to the relaxation of the ligaments of certain joints in the body, such as the hip and pelvis.

Pregnancy itself does not cause a higher incidence of sciatica, but rather it is a condition that occurs in people who previously had a back injury.

Simple measures can help prevent early sciatica in pregnancy:

-Practice moderate exercise: Practices such as walking, swimming or yoga contribute to strengthening the abdominal muscles while avoiding a sedentary lifestyle, two factors that help prevent discomfort in the back.

-Control weight in pregnancy: An excessive weight increase causes a greater compression of the sciatic nerve.

– Postural changes: Bad postural habits contribute to the appearance of pain. You must take into account some measures to avoid it: not sitting for long periods of time, do not cross your legs when sitting; stoop always bending the knees; keep your back straight when you sit and walk.

-Mild massage: They help relieve pain and tension in the lower back, especially when accompanied by relaxation and elongation techniques.

-Use appropriate footwear: It is not good that the shoe is completely flat or that it has an excessively high heel. The right measurement is between 3 and 5 cm.

-Put a pillow between your legs when sleeping: To relieve pain if you sleep on your side, or a pillow under your legs if you fall asleep on your back.

-Apply dry heat: When the pain appears, apply heat in the area several times a day. Hot water baths can also be given, as long as the water temperature is not excessively high.

-Avoid self-medication: Never take analgesics or anti-inflammatories without the express authorization of the attending physician.