It is a question that we see in the consultations very frequently. I will tell you the most important facts that determine the need or the preference of an intervention. The diagnosis of sciatica is not always simple and requires experience with this type of injury. Not all the pains that go down the leg are sciatica, much less. And not all sciatica is caused by herniated discs.
If we have an L5-S1 herniated disc, the most frequent is to have only a low back pain. Sometimes the disc, which has left its place, compromises the space that the nerve roots have to leave towards the legs. If there is an entrapment of this root, typical symptoms of sciatica will occur.
The consequences that sciatica can have depends on the degree of injury of these nerves. Keep in mind that these nerve roots carry the sensitive information and signal that the muscles need to contract and move the joints. The sensitive information is composed of fibers that carry the sensation of touch, others inform us of temperature and others of the damage with sensations of pain. The motor roots are those that move the muscles and are the ones that worry us the most from the point of view of gravity.
The most frequent in the case of suffering from sciatica is that we have a lot of pain and unpleasant sensations like tingling or lack of sensitivity in some areas of the legs. In the case of an L5-S1 hernia the typical pain is a pain that goes down the back of the thigh in the form of a cramp until it reaches the sole of the foot and that causes tingling in the area of the twin and the sole of the foot. Here the sensitive part of the nerve is being affected.
If the situation is more serious and the area of the nerve that moves the muscles is damaged, we will lose strength. In the case of the L5-S1 hernia we will lose the ability to stand on tiptoe with the affected foot and we will have instability and lack of balance when supporting that leg.
Once this is explained, when do I operate?
First of all I must clarify that I am giving information so that we understand this illness better but that it is up to the doctor and / or surgeon who takes our case to determine our situation and needs. Most herniated sciatica will heal on their own. This means that very few will need surgery. For this reason, if there are no complications we can expect and monitor the evolution, controlling pain with medication. When I say healing, I mean that sciatica will go away and we will stop having the pain. The disc will still be damaged but it does not have to cause us problems.
If we suffer from muscle paralysis as explained above, it is a more serious complication and a surgical intervention with some urgency may be necessary. Even in these cases, they are not always operated and can be recovered with medical treatments.
If we do not have a muscle paralysis, knowing that most will heal on their own, the most sensible thing to do is wait and see (with the right medical treatments for the least possible discomfort). Only if the pain lasts a long time, we do not see an evolution towards improvement and our life becomes a hell, it may be advisable to be intervened.
In short, few herniated discs will need surgery but when it is necessary may require a certain urgency. Not everything is described in this post since the variants are many but this is the usual situation of an L5-S1 disc herniation. It is not always easy to know what is affected and what is not. It requires a clinical examination of a person with experience in this field and on occasions of tests such as magnetic resonance and electromyography.
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