Sciatica Case Study

History

The patient is a 21-year-old female college varsity athlete who presents with a 4 month history of sciatica. Despite aggressive physical therapy and two separate nerve root injections, the severity of the symptoms forced the patient to step aside as a competitive member of a rowing crew team.

Examination

Symptoms include low back and left-sided buttock and leg pain. Pain also radiates into her foot. Her pain varies between 6 and 9 and worsens during athletic activity.

The neurological examination was normal with positive straight leg raise.

Prior Treatment

Under the university's trainer, the patient tried non-steroidal anti-inflammatory drugs and physical therapy.

Imaging

Figure 1. Sagittal CT scan shows a L5-S1 disc extrusion.
The bulge at L4-L5 was considered clinically insignificant.

 

Figure 2. Axial CT scan of L5-S1

 

Diagnosis

Extruded disc at L5-S1, paracentral location

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Selected Treatment

Xclose™ Tissue Repair System (Anulex™ Technologies, Minnetonka, MN) allowed us to accelerate the patient's rehabilitation (aerobic conditioning started at 3 weeks) and, hopefully, prevent reherniation.

During surgery, a large extruded fragment was found with discrete anular disruption, which I repaired.

 

Xclose™ Tissue Repair System video demonstration

The Xclose™ Tissue Repair System is indicated for use in soft tissue approximation for procedures such as general and orthopedic surgery.

Financial Disclosure
Thomas A. Zdeblick, MD is a Consultant for Anulex™ Technologies.

Outcome

The patient began aerobic conditioning exercises at 3 weeks postop. She returned to training at 4 weeks and competition at 6 weeks after surgery. So far, she has returned to competition with no evidence of herniation recurrence. The sagittal and axial MRI scans (Figures 3, 4, below) were taken at the patient's 4 month postoperative visit.

Figure 3. Postoperative sagittal CT scan

Figure 4. Postoperative axial CT

 

 

Patient Disclaimer: This case reflects one patient’s/surgeon’s experience.  Not every person will receive the same results.  Talk to your doctor about your treatment options.

 

 

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Anular repair represents an emerging technology with significant implications, especially in the young patient with a focal extruded fragment.

Personally, I would have tried an epidural steroid injection as the next line of treatment, especially with a normal neurologic exam. Free fragments such as this will often involute and resorb. However, if resorption alone were adequate, one would have expected some clinical improvement by 4 months post-injury. Furthermore, the anular defect would persist and may never reach the integrity provided by the open anular repair.

In this patient, the more aggressive intervention led to a shorter recovery and faster return to competition. The young age of this patient, combined with her thick anulus and well-defined, small defect made her a good candidate for anular repair.

Dr. Zdeblick has obtained a beautiful outcome clinically and radiographically with remarkably little trauma to the surrounding tissues on MRI.

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A 41 year old female presented to our clinic suffering with severe back pain and sciatica. She had been experiencing pain for 5 and a half years and her pains were getting worse. When she started treatment her pain in her back an in her leg was a 9 on a scale of one to ten. (10 being the worst)

She was experiencing a clasic case of sciatica; the pain started in her back and traveled from her back all the way down her leg into her foot.

She had x-rays before she came in to see us and we ordered an MRI.  The MRI revealed the she had;

I have a video of the 5 main causes of sciatica, and she had all 5. She was in bad shape and was definitely getting worse.

Over the last few years she had tried all possible treatments and found temprorary minimal relief, only to have the pain  eventually get worse. She had courses of care with the following;
 

  1. Physical Therapy
  2. Chiropractic
  3. Epidural Shots
  4. Pain Medication, Including Ibuprofin, and Muscle Relaxers
  5. Narcotics
     

She had seen 4 separate specialists before entering our clinic including a consultation with a surgeon who recommended surgery for her back.  Six months before coming into our clinic she had 3 injections into her spine to help eliminate her pains.  The shots were effective for a few weeks before the pain came back. 
 

She had diminished reflexes in her leg as a result of her pinched nerve, and was also showing signs of weakness.  Her core was weak and she lacked endurance with simple activities.
 

When she started therapy with our program her pain was a 9 and her ODI was a 42%. Because she was experiencing the pain for over 5 years, in conjunction 5 different therapies and her ODI was still over 40% she was a prime candidate for surgery. 
 

For More Information About ODI and Insurance Criteria for Surgery Click Here

Her goal was avoid the surgery, but we were difinitely her last hope.
 

After her first 12 treatments her pain was down to a 2 from a 9, she no longer had pain and numbness in her foot. Her reflexes were back to normal and her ODI score was 22.  She was making better progress then she had in the last 5 years.

After 30 treatments her pain was at a 0, she no longer had any numbness and pain down her leg. Her core strength was better and her ODI was a 16.  ODI below 20 is considered the safe zone in therapy.  
 

Recap;

  1. Patient had over 5 years of pain
  2. Herniated Disc, Bulging Disc, Degenerated Disc, Stenosis and Sciatica
  3. Pain in her back and leg and foot
  4. Pain when started at a 9
  5. ODI when started 42
  6. Pain in her back and log a 0 when finished care
  7. ODI 16 when she finished, into the safe zone.

We saved her from and inevitable surgery.  Any patient that has back pain for more than a year and receives therapy and still has an ODI score above 40 is a candidate for surgery, and this was the case with our patient. We were able to get her out of pain and create functional stability so she can live pain free.
 

If you have pain or feel like you have no options for pain relief, call now 

1-855-290-6404 

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