Dr. Gianni De Berti, neuroradiologist of Villa Verde, talks about the noise of low back pain and sciatica, affecting about 80% of adults at least once in a lifetime
Low back pain and sciatica low back disorders are extremely common, affecting about 80% of adults at least once in their lifetime. They are among the most frequent causes of absence from work and therefore have a high socio-economic impact.
We can distinguish a chronic form and an acute form. In the first case, the intensity varies if the disorder persists for long periods of time, even for several years, accompanying and restricting to varying degrees the activities of the affected person. In the second the term “acute” refers not only to the intensity of pain that can be in many cases actually very intense, dramatic, but especially to the mode of occurrence relatively fast, in a short span of time. In the case of low back pain sciatica-acute disorder is usually limited in time, sometimes spontaneously, most often due to medical care. In some cases, an acute form can not heal and result in a chronic form.
“Low back pain” refers to pain localized to the lumbar belt and that can appear in various situations such as walking or in keeping the sitting or standing position for a long time. It speaks of “sciatica” when the pain radiates to the lower limb. Depending on the situation there may be irradiations of pain also to other districts, such as the groin or the gluteal region and then one speaks more appropriately of “irradiation topography root”.
The terms low back pain and sciatica are themselves descriptive to indicate generically a symptom but without giving any specific definition of whatever its cause and nature.
Dr. De Berti, what are the most common causes of low back sciatica?
The causes can be very varied and numerous as the lumbar region is made up of a complex set of factors many of which can generate pain. Among them the best known is certainly the intervertebral disc but also other elements.
So the herniated disc is not the only possible cause.
Absolutely not. The disc is only one of the possible reasons for a sciatica, surely one of the most common but not the only one. Besides, it would be appropriate to speak of diseases discs in a broader sense as the hernia is only one of the possible issues that may affect an intervertebral disc. Not only hernias are very different from each other and must be accurately categorized as different types of hernia may have different fate and suffer from certain treatments, but not of others. The hernia of an individual is almost never, in fact, equal to that of another.
What are the tools then to arrive at a correct diagnosis?
The specialist has two basic tools available, or CT and MRI. The first allows you to make judgments more accurate on the bone component and the second is much more sensitive to the study of other elements such as the disc and nerve roots. It will be up to the specialist to choose based on the clinical suspicion to which of the two instruments rely.
What is the minimally-invasive therapy?
Classically therapies for lumbosciatica are divided into physical, medical, surgical. Medical and physical therapies are so-called “conservative” while the surgical options are so-called “invasive”. There is a new scenario of increasing therapeutic possibilities that lay conceptually halfway between the two previous. They are therefore called minimally invasive. These are techniques that allow to access with special instruments to the locations of origin of the pain under guidance of X-ray equipment (usually CT). Access is permitted by special needles and therefore does not exist cuts and anatomical parts are not modified as in the case of traditional surgery.
Could make an example of these methods?
The most common and well known is the infiltration under CT guidance. Contrary to the commonly held is not a practice always equal to itself (often identified as the “epidural”) but of a variety of possibilities that provide for the achievement with the needle of various anatomical structures depending on the diagnosis. The epidural is therefore only one of these possibilities. Only the use of CT enables the achievement of such precise deep structures minimizing risks. There are other treatment options minimally invasive that will aim to change the hard seat of pathology to lessen the painful effects that it generates.
How the use of a strategy minimally-invasive therapy instead of another is chosen?
The selection and signs must be placed by a specialist doctor who will perform the procedure. The first necessary step is therefore the clinical evaluation of the patient with analysis of neuroradiological investigation adequate. It will be diagnosed and evaluated the feasibility and advisability of a choice minivasiva. Any practical act in the final room TAC is in fact only 50% of the competence of the interventional neuroradiologist: the other 50% is exercised in the clinic, in the considered choice of the appropriate strategy to employ.