Marc Darrow, MD, JD

Many people that we see at our Los Angeles joint rehabilitation center  are contemplating surgery for their sciatica pain. In a majority of cases, surgery may not be needed, in fact surgery may be the inappropriate choice. To be clear, surgery may be necessary for people with severe sciatic pain, significant leg weakness, or alterations in the bowel or bladder function. However, the great majority of people we see are not being challenged by these conditions.

“I have been considering an epidural. I’m waiting to have a microdiscectomy. I have severe sciatica. Can you help?”

This is the type of email we get: “I have been considering an epidural. I’m waiting to have a microdiscectomy. I have severe sciatica. Can you help?  I need to get back to work.”

When an email like the one above comes in we have to take a realistic approach to how we would answer this person. We may ask initially:

Thank you for writing and we are sorry to hear about the challenges you are facing. Is the sciatica causing you pain in your back or hips or does it go down your legs and feet? How long have you been out of work because of this? What do you do for a living? How long have you been waiting for a surgery? We will reach out to you so we can start getting some information and an understanding of how to proceed in your case.

What we are trying to do with this email is get a realistic assessment. If this person has true sciatica with neurologic symptoms of radiating pain into the feet or bladder malfunctions they need to follow the recommendations of their neurologist. However, many people without these severe symptoms are often recommended to a surgery they did not need.

The erroneously diagnosis of sciatica and the recommendation to unneeded back surgery.

Doctors at the Mayo Clinic (1) have published a paper entitled: Comparative role of disc degeneration and ligament failure on functional mechanics of the lumbar spine. In this paper the Mayo Clinic researchers wanted to make a clear definition between two problems affecting low back pain patients.

  • First, that pain could be coming from the discs.
  • Second that pain could be coming from the spinal ligaments.

The Mayo researchers suggest that recognizing between the two could prevent an erroneously diagnosis of sciatica or back surgery.

Once clue:

  • If a patient has instability, excessive movement, and decreased stiffness, doctors should examine for ligament damage.
  • If the opposite, less movement, more stiffness, the doctor should look for disc disease.

The ligaments of sacroiliac joint, the anterior sacroiliac ligament, Interosseous sacroiliac ligament, Posterior sacroiliac ligament, Sacrotuberous ligament and Sacrospinous ligament may contribute to sciatic nerve entrapment when injured. How? By allowing hypermobility in the lumbar vertebrae. The vertebrae will slip out of place and possibly compress the sciatic nerve.

Our non-surgical treatment options

In our practice, Bone Marrow Aspirate or bone marrow derived Stem Cell Therapy is a treatment for musculoskeletal disorders. We treat degenerative joint disease, degenerative disc disease of the spine, and tendon and ligament injury.

Schedule a free phone consultation today and receive our exclusive Regenerative Medicine Stem Cell & PRP Quick Start Guide —a digital resource packed with:

  • Insights into Stem Cell & PRP Therapy
  • Research-backed treatments for chronic tendon injuries, joint pain, arthritis, and sports injuries

Take the first step toward a pain-free, active life today.

References

1 Ellingson AM, Shaw MN, Giambini H, An KN. Comparative role of disc degeneration and ligament failure on functional mechanics of the lumbar spine. Computer methods in biomechanics and biomedical engineering. 2016 Jul 3;19(9):1009-18.