In the first four or six weeks, if there is no alarm data - loss of strength or alteration of the sphincters - a treatment is started from anti-inflammatory drugs. Epidural infiltrations of corticosteroids, or vertebral manipulations. Physiotherapy may have a transient relief effect. After four to six weeks, or in case of loss of strength or sphincter control, surgical treatment is recommended.
If the cause of the pain is a herniated disc it will be necessary to treat with surgery. The indicated one is the discectomy (to remove the disc fragment that compresses the root). It is not necessary to perform an arthrodesis (fixation with screws), unless there is demonstrated by a dynamic x-ray an instability or it will create instability by surgery, as in very large hernias with great compression of the roots, in very lateral hernias that Need to remove the vertebral joints and in cases of recurrent herniated discs.
Risks of surgery for sciatica
Although the results of the surgery are very good, any intervention has its characteristic risks. In this case they are: the lesion of the dura mater (the covering of the nerve roots) that provokes the exit of cerebrospinal fluid and the injury of the affected root or the rest of the roots that are at that level.
The dura lesion does not have a poor prognosis and most of the time it is resolved during the procedure or with a longer period of rest during the postoperative period.
Root injury has a worse prognosis, and may lead to loss of strength or tenderness, postoperative pain and, exceptionally, loss of sphincter control.
The recurrence of pain due to fibrosis is another documented fact whose origin is not well known. It consists of the reatrapamiento of the nervous root intervened by the appearance of a scar around it. Another risk is not uncommon is the level error, although the use of radiological controls during the intervention minimizes this risk.
Postoperative and Sciatica Surgery Results
The postoperative period of a lumbar microdiscectomy usually involves an admission of about 24-48 hours, although it can be done even on an outpatient basis, depending on the patient and the location of the hernia, as well as the technique used.
Relative rest is advised for about 10-15 days and thereafter a progressive reincorporation to the patient's usual activities. In cases of high physical demand (elite athletes, heavy loads, etc.), the recovery period is prolonged.