Sciatica 5

Physiotherapy

Sciatica 1

Manipulation

Sciatica 6

Acupuncture & Dry Needling

Sciatica 2

Specialist Back Pain Doctors

Sciatica 3

Spinal Injections

Sciatica 4

X-Ray Guided Injection Theatres

How it is treated

Sciatica is a debilitating condition caused by the irritation of the sciatic nerve, usually by a prolapsed or herniated (slipped disc) in the lumbar spine. It can be treated by oral anti-inflammatory medication and manual therapies, but in some severe or long-lasting cases a spinal injection provides rapid benefit by getting the anti-inflammatory medication as close as possible to the irritated nerve root. These injections, known as caudal epidural or nerve root blocks, are performed under X-ray guidance to allow the accurate placement of the treatment needle. At the Blackberry Clinic we have two state-of-the-art fluoroscopic (digital X-ray) theatre suites to allow rapid treatment of sciatic pain.

In recent decades, cortisone medications have been injected into the space around the spinal nerves (epidural space) to reduce the inflammation and swelling of the disc herniation, thereby relieving irritation of the adjacent nerves. The advent of fluoroscopic techniques have allowed this to be done safely as an outpatient procedure under the care of one of our specialist back pain doctors.

A study, by Simon Carette MD and others from Laval University and the University of Montreal, looking at the long-term benefits of epidural injection for Sciatica from disc herniation was published in the New England Journal of Medicine. Dr Carette's study found that epidural injections for disc herniation of the low back relieved pain in the leg. Other studies by back pain specialists have shown similar results. The following abstract is from a study looking at intractable back pain and the use of caudal epidural injections for its treatment:

"This preliminary study assessed the efficacy of epidural injections of 80 mg triamcinolone acetonide plus 0.5% procaine hydrochloride in saline, administered via the caudal route, in a double-blind, placebo controlled trial with 1 year follow-up. Twenty-three patients were entered into the study: 12 received treatment and 11 placebo. The active group showed significant pain relief (P=0.02) and a significant increase in mobility (P=0.01) at 4 weeks, which resulted in improved quality of life (P=0.02). At 1 year, subjective and objective measures improved in both groups. The improvement was greater in the actively treated group."

Bush K, Hillier S. A controlled study of caudal epidural injections of triamcinolone plus procaine for the management of intractable sciatica. Spine. 1991;16:572–