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Sciatica: investigations and surgical treatments SCIATICA: INVESTIGATIONS AND SURGICAL TREATMENTS
While the vast majority of instances of sciatica and lower back pain will respond to fairly simple treatment within a matter of weeks -or even much more quickly than that - there will always be some that will be more intractable, either not responding at all to just rest and analgesics or responding so little that it becomes evident that other treatments have to be considered. When that happens, a patient will usually be referred by his doctor to a specialist at the out-patient department of his local hospital.
Your initial consultation with a specialist will generally follow a similar pattern than when you first saw your own doctor: a history of the problem will be taken, additional questions will be asked, and there will be a further physical examination, this then probably followed by yet more questions.
At the end of your consultation, your specialist may well ask for various tests or other investigations to be done before making his diagnosis. Depending upon the circumstances, the purpose of these tests may be three-fold:
To specifically identify the cause of your troubles, if that's not already known; and
To eliminate other disorders which may be marked by similar symptoms; and
In those comparatively rare instances where an operation appears indicated, to help pinpoint exactly what approach is likely to work best. Tests and investigations commonly used include:
X-rays. While radiography is widely used in the diagnosis of many other disorders, its results are unfortunately often disappointing when back problems are being investigated, the difficulty being that many of the subtle changes in the spine that cause pain simply fail to show up clearly enough, especially during their early stages. Additionally, it takes a pretty large dose of radiation to X-ray the spine, and this is something that is best avoided unless truly indicated.
Computerised tomography (or CAT- or CT-scan). Using much smaller doses of X-rays, this scanning method records the different thicknesses of tissues, translating these findings through the intermediary of a computer on to film that provides a cross-sectional image.
Magnetic resonance imaging (or MRI). Producing images rather like those from a CAT-scan, this technique uses very powerful electromagnets instead of X-rays, so making it free of the risks that can accompany radiation.
Myelogram. This is a specialised method of X-ray examination in which radio-opaque contrast medium is injected beforehand into the subarachnoid space in the spinal cord. Although this method is of particular value in recognising tumours of the spinal cord (as well as other conditions in which the cord or nerve roots are compressed), it needs to be accepted that this investigation represents a major intervention in itself and that therefore the patient should be made aware of the risks and side-effects that can be involved.
Blood tests. These can provide information about a wide range of disorders, including many different types of rheumatic diseases.
While all these tests - and several others - are potentially available, it is highly unlikely that all will be requested or that even more than just one or two will be done.
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