musculoskeletal and connective tissue disorders
Sciatica
Treatment of Sciatica
Activity as tolerated, analgesics, and sometimes drugs that relieve neuropathic pain Physical therapy Sometimes oral or epidural corticosteroids Surgery for severe cases ), can be tried for up to 6 weeks. Drugs that decrease neuropathic pain (see Treatment ), such as Muscle spasm may be relieved with therapeutic Heat or Surgery is indicated only for Symptoms and Signs or for unequivocal disk herniation plus one of the following: Muscular weakness that is worsening or not resolving Other progressive neurologic deficits Intolerable, intractable pain that interferes with job or personal functions in an emotionally stable patient and that has not lessened after 6 weeks of conservative treatment Classic diskectomy with limited laminotomy for intervertebral disk herniation is the standard procedure. If herniation is localized, microdiskectomy may be done; with it, the skin incision and laminotomy can be smaller. Chemonucleolysis, using intradiskal injection of chymopapain, is no longer used. Predictors of poor surgical outcome include Prominent psychiatric factors Persistence of symptoms for>6 months Heavy manual labor Prominence of back pain (nonradicular) Secondary gain (ie, litigation and compensability) 