Conservative/Non-operative treatment of Sciatica

Most of the patients of sciatica get better with nonoperative treatment. The word sciatica refers to the pain along the distribution of the sciatic nerve. The medical terminology for sciatica is lumbar radiculopathy. It is usually present on one side only.

Sciatica is a pain that starts from the lower back and radiates into either leg. It usually radiates along the outside or the back of the thigh and leg. It can also radiate along the inner leg or the front of the inner thigh depending on the level involved. The pain can go over the front of the foot or into the sole.

Axial section of the spine at L5-S1 level on an MRI

Axial section of the spine at L5-S1 level on an MRI

This radiating pain can be associated with tingling or numbness. Occasionally, there may be some weakness in the toes also. Rarely, a profound weakness can be found in the ankle, knee or the hip.

The prevalence of sciatica or lumbar radiculopathy is about 10 per thousand patients and may be more commonly involved in women. In patients presenting with sciatica, 90% do have lumbar disc herniationhttps://www.cortho.org/spine/herniated-disc/. Approximately 5% of people will experience sciatica in their lifetime.

The pain is due to a combination of inflammation and decreased blood supply to the nerve root commonly known as a nerve root irritation. The most common cause of this irritation is disc herniation. Other uncommon causes can be facet arthritis and synovial cyst.

Sciatica occurs in relatively younger people. Sciatica may be associated with back pain, but it can also present without back pain. Rarely, a sciatica may be associated with sudden or progressive neurological deficit in the form of weakness or involvement of bowel or bladder.

Sagittal section of the lumbar spine on an MRI.

Sagittal section of the lumbar spine on an MRI.

The sciatica is mostly treated conservatively, especially the initial phase. Mode of treatment includes medications, physical therapy, chiropractor and acupuncture among others.

Medications that can be used for sciatica include nonsteroidal antiinflammatory medications like naproxen or ibuprofen, narcotic medications like tramadol, oxycodone and hydrocodone. Oral steroids in the form of Medrol Dosepak can be used. Occasionally, the medications can be supplemented with gabapentin or pregabalin or tricyclic antidepressants with good results. Pharmacological treatment of radiculopathy may also involve use of tricyclic antidepressants like amitriptyline, anticonvulsants like gabapentin and pregabalin.

Physical therapy can be initiated in patients with sciatica. The therapy includes isometric and isotonic exercises to strengthen their muscles of the back, abdominals and obliques. It also includes stretching as well as pain modalities like ultrasound, interferential therapy, heat and cold therapy, TENS unit etc.

Alternative therapies including massage, acupuncture, acupressure as well as chiropractic care are sometimes being found useful. The patient can have one or a combination of these therapies. Traction can also be used in the treatment of sciatica.

The therapy needs to be continued for 4 to 8 weeks for good results. Patients who do not improve or deteriorate with therapy should seek attention and see their spine surgeon. Short-term rest for up to 1 to 2 days has been proven in the treatment of sciatica. Long-term rest more than 2 days has not been found beneficial, but rather has been found detrimental in the management of back pain and sciatica.

Surgical treatment of sciatica is only needed if all the conservative managements have failed and the pain affects the activities of daily living as well as work. Patients presenting with sciatica associated with sudden or progressive neurological deficit in the form of weakness or involvement of bowel or bladder may need urgent surgery to stop the progression and optimize the conditions for recovery.

Minimal Invasive pain intervention for Sciatica

There are multiple minimal invasive pain interventions that have been tried in patients with lumbar radiculopathy or sciatica. These include epidural steroid injection (ESI), selective nerve root block (SNRB), disc decompression surgery using laser (laser discectomy), radiofrequency coblation (nucleoplasty), intradiscal oxygen ozone (O3) as alternatives to surgical treatment.

Researchers have shown consistent results from steroid injections, either epidural or selective nerve root block. Other procedures have also been used with limited success.

To perform an epidural injection, a needle is introduced from the back into the spine just outside the dura or the linings of the nerve roots and steroid mixed with local anesthetic is infiltrated. This steroid spreads out to bathe the nerve roots at that level as well as the levels above and below leading to decrease in inflammation. This causes improvement in symptoms and decrease in pain.

Epidural injection can be given through three different approaches namely caudal, interlaminar or transforaminal. Various steroids can be used including triamcinolone, methylprednisolone, betamethasone and dexamethasone.

Selective nerve root block is usually performed over the nerve root involved. A needle is put near the nerve root and a small amount of steroid with local anesthetic is injected. Selective nerve root block is a selective procedure and is diagnostic along with being therapeutic hence identifying the nerve root causing the problem.

These procedures are relatively safe procedures with good success rate. Complications of these procedures may include inadvertent injection of steroid into the dura or vessel, which can sometimes be catastrophic. Other complications include worsening of the pain, non-recovery or no benefit from the pain after the injections.

Patients who undergo epidural injection or nerve root block should maintain a pain diary and check and document their pain at 2 hours, 4 hours after the procedure as well as twice daily for the next 2 to 3 weeks. These patients can restart physical therapy within 3 to 5 days of the procedure.

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Based on 93 reviews
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
Sam
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
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I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.