Sciatica is a surprisingly common result of trauma to the lumbar spine. The extent of the pain and limitation and whether the condition is temporary or permanent, varies considerably from person to person, but the type of treatment and when it is received can play a crucial role in the long term prognosis.
The sciatic nerve is the longest nerve in the human body, running from hip to foot. The most common cause of sciatic pain is a prolapsed disc in the lumbar spine. The prolapsed disc puts pressure on the sciatic nerve which runs close to the spinal column, resulting in pain, commonly in the buttock and outer side of the leg. It can also cause neurological problems in the foot, including numbness, pins and needles and reduced or loss of ankle reflex.
Accordingly, whilst the majority of the symptoms are experienced from the buttock to the foot, the cause of the problem lies in the lower back.
As we age, our intervertebral discs, which act as shock absorbers between our vertebrae, start to degenerate. This natural degeneration may reach the point where we develop sciatica and other symptoms naturally. The rate of that degeneration varies from person to person, with a few people starting to experience ‘the odd twinge’ by their late twenties or early thirties, but in most people that will not happen until they are much older, possibly into their forties, fifties or even older.
However, the trauma of an accident can accelerate the onset of the symptoms of degeneration. In other words, the accident does not cause the degeneration, which is present anyway even though the person may have no history of symptoms, but can bring forward the onset of those symptoms, often by many years.
For example, in a recent case a client in her mid-thirties was involved in a high impact road traffic collision. She had no prior medical history of back pain or similar symptoms and yet shortly after the accident she developed severe, debilitating sciatica. An MRI scan revealed that the cause was a prolapsed disc in her lower back, but the radiological evidence showed that her spine was otherwise perfectly normal and healthy for her age. The respected spinal surgeon that we instructed to report in her claim concluded:
“On balance, had she not have been involved in this accident I see absolutely no reason why she would have gone on to develop the acute pain and chronic symptoms of sciatica that she has. However, even in the unlikely event that she had started to have some level of symptoms many years down the road, it would be highly unlikely that they would have been as severe as they are now. The other consideration is that any natural onset of symptoms would have been far more gradual and therefore more amenable to treatment.”
Choosing the right medical expert is absolutely crucial in a claim involving sciatica. A good lawyer should be able to recommend to you one or more spinal specialists that they have worked with who will be unfazed by the barrage of hostility they will inevitably face from the other party when providing an opinion on the accelerated onset of symptoms. Certainly avoid any lawyer who suggests instructing a medical reporting agency to identify a medical expert!
Treatment for sciatica
Early treatment is vital and surgery is far from the first consideration. Strong anti-inflammatory medication such as Naproxen is often prescribed for the pain. This is not curative but can help levels of pain and therefore improve daily function.
Physical therapy is an often helpful sciatic nerve treatment, even just to provide some short term relief. Common examples are physiotherapy, osteopathy, chiropractic and the Bowen Technique.
If sciatica is treated with physical therapy, do not expect an instant cure. Rather, an intensive course of treatment over several weeks is usually required, combined with home exercises to improve core body muscle strength to provide additional support for the spine.
Even if not curative, physical therapy can help to reduce symptoms to a level where life again becomes tolerable and the issue then becomes one of adjustments to lifestyle as part of ongoing symptom management.
If physical therapy fails to work, either at all or not sufficiently to improve a person’s quality of life, then more invasive options may be considered.
The first port of call would likely be referral to a spinal surgeon, who will invariably request an MRI scan to look more closely at the underlying cause of the symptoms. If, following the results of the scan, surgery is an option, the likely recommendation with be a discectomy procedure, where as much as possible of the protruding part of the disc is cut away and removed to relieve pressure on the sciatic nerve. This is almost always carried out as a ‘keyhole’ procedure.
There is certainly no guarantee that a discectomy will succeed. Many years ago the writer underwent a discectomy with excellent results and an almost complete recovery from his sciatica. However, a proportion of patients do not improve with surgery and a small number actually experience a worsening of their symptoms.
Whether or not a person proceeds with surgery, another slightly less invasive route is referral to a consultant in pain medicine to not only review the issue of medication, but to consider a selective nerve root block procedure (SNRB). An SNRB may be used as a diagnostic tool, but may also provide some short to medium term relief of symptoms. There are a number of options in the pain specialist’s armoury, ranging from the injection of local anaesthetic and steroid, through to Radiofrequency Ablation, where an electrical current is used to burn selective nerves to interrupt the pain signals to the brain. This will be carried out with the help of x-rays to ensure that the probe is in exactly the right position.
There are of course a host of treatments for sciatica not mentioned in this article; some conventional, others less so. We have simply sought to illustrate some of the more common forms of treatment on offer.
Whilst a lawyer is not qualified to advise a client in respect of treatment per se, they should nevertheless have a sufficient knowledge of treatment options and treatment providers so as to be able to provide guidance to their client on where that treatment advice may best be obtained. The lawyer may even nominate a specialist to co-ordinate their client’s treatment. Beyond that, the lawyer’s role in treatment is to fight to ensure that prompt and adequate funding is forthcoming from the other party so that there is no delay in treatment.
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