What Is the Best Treatment for Sciatica?

From webmd.com

Sciatica is pain that starts in your lower back and shoots down through your legs. It usually happens when something, such as a herniated disk or bone spur, presses on your sciatic nerve. You might have sharp, intense pain, as well as tingling, weakness, and numbness in your legs.

It causes pain and discomfort, but there are many treatments for it. Most people with sciatica don’t end up needing surgery, and about half get better within 6 weeks with home treatment, rest, and medication.

Your sciatic nerve branches off from your spinal cord. Pressure on the nerve can cause pain. (Photo credit: iStock/Getty Images)

Home Sciatica Treatment

Many mild cases of sciatica can be treated at home. Even more severe cases that need medical treatment can be helped by these home treatments.

Rest

Avoid strenuous activities. Light activities such as walking and stretching are good for you, but you want to avoid putting any more stress and strain on your back.

Ice and heat

Using an ice pack can help reduce some swelling and pain. Heat can also soothe your discomfort. For the first few days, use an ice pack several times a day for 20 minutes. After that, you can switch to using a warm compress or a heating pad several times a day for 20 minutes.

Sciatica stretches

Some of the best stretches to relieve sciatica pain focus on the piriformis muscle, which runs from the bottom of your spine to the top of your thigh. Stretches for your hamstrings, which are the muscles along the back of your thighs, can also help.

Here are two to try:

• Piriformis stretch: Lie on your back with your knees bent and your feet flat on the floor. Lift your right foot off the floor and cross your ankle over your left knee. Let your right knee fall out to the side. Next, lift your left foot off the floor and use both hands to grab around your left thigh. Gently pull it toward your chest. You should feel the stretch in your rear end. Hold for 30 seconds, then switch sides.

• Hamstring stretch: Lie on your back on the floor with your left knee bent and foot on the floor and your right leg stretched out. Lift your right leg and grab behind the thigh with both hands. Keep the leg as straight as you can and pull it towards you. You’ll feel this stretch along the back of your thigh. Hold for 30 seconds, then switch sides.

• 
  

• Sciatica exercises

  Improving your core strength can build support for your spine and help you avoid sciatica. Your core muscles are the muscles around your midsection -- your abdominals and lower back.

  Do these exercises a few times a week:

  Trunk rotations: Lie on your back with your feet flat on the floor and your knees together. Lift your feet and bring your knees slowly over to the right side. Keep your shoulder blades pressed into the ground as you do this. Go as far as you can without your left shoulder blade coming off the floor. Then bring your legs back through the centre and over to the left. Keep moving back and forth, repeating the sequence 10 times on each side.

  Plank: Get on all fours with your shoulders over your wrists. Tuck your toes and walk your feet back so your knees lift off the floor and your body is in one straight line from your feet to your head. Pull your core muscles in tight and hold this position for 15-30 seconds. Put your knees down to rest for a bit, then do the exercise two more times.

  Over-the-counter medicines

  Nonsteroidal anti-inflammatory medicines such as ibuprofen can relieve pain and swelling.

  Non-surgical Sciatica Treatment

  If other therapies and over-the-counter medications aren't working for you, you still have options that don't include surgery.

• Prescription medications and injections for sciatica

  Your doctor may give you a prescription medication such as painkillers and muscle relaxers. Tricyclic antidepressants such as amitriptyline (Elavil) and anti-seizure medications can work for nerve-based and chronic pain.

  Corticosteroid injections can offer relief for up to 3 months.

  Yoga for sciatica

  As yoga combines stretching and low-impact strength training, practicing it regularly may help you heal and prevent sciatica. Try these poses to keep your spine and hips flexible:

  • Dragon pose: Start in a tabletop position, then bring your right foot between your hands. Next, slide your left leg backward, keeping your toes tucked. You should feel a stretch in your left hip and thigh. Hold the pose for up to 5 minutes before switching sides.

  • Cobra pose: Lie on your stomach with your legs together and place your palms on either side of your chest. Next, lift your head, chest, and stomach up towards the ceiling using mostly the strength in your lower back muscles. Repeat this move four to five times.

  • Sciatica massage

    The main way massage therapy can help you with sciatica pain is by relaxing tight muscles that put pressure on your sciatic nerve. Massage therapy also boosts blood flow to the affected area, speeding up healing.

    Other sciatica-supportive therapies

    Research shows that acupuncture can help you safely manage sciatica pain. During treatment, an acupuncturist places thin needles into your skin to stimulate your body’s nervous and immune systems, which releases natural endorphins that help relieve pain. A natural therapy called biofeedback can be helpful. Therapists use sensors to monitor your body and teach you how to better control some functions, such as muscle tension.

    Should I see a chiropractor for sciatica?

    A chiropractor might be able to help your sciatica. They will make adjustments to your joints to help realign your spine, which may ease pressure on your sciatic nerve. They can also recommend stretches and other strengthening exercises.

    Sciatica Surgery

    Very few people need to have surgery for sciatica. If you have severe symptoms that make it hard to do your everyday activities, or if there are signs that your sciatica is causing nerve damage, your doctor might recommend surgery.

    The are several options for sciatica surgery:

    Microdiscectomy. During this procedure, your surgeon removes small pieces of bone, disk, and ligament pressing on your nerve. It's considered a minimally invasive procedure that only requires a small incision. You’ll have general anaesthesia to put you to sleep so you don't feel anything. You'll usually be able to go home the same day.

    Laminectomy. The lamina is part of the ring of bone that covers the spinal cord. During a laminectomy, your surgeon removes the lamina and any tissue pressing on the nerve that’s causing you pain. You will get general anaesthesia, meaning you will not be awake during the operation. You’ll be released from the hospital the same day, with instructions to start walking the day after you get home.

    Foraminotomy: Your vertebrae protect the nerves that run through your spine, but sometimes the opening where they leave the spinal canal is too small, putting pressure on your nerves. During a foraminotomy, your surgeon will widen the opening and remove any blockages. You’ll have general anaesthesia for the operation and should be able to go home 1 or 2 days later. Your doctor might recommend that you avoid certain movements for a while, but most people can return to light exercise within a few weeks.

    Spinal fusion surgery: Spinal fusion surgery joins two or more vertebrae together, usually with screws and metal rods. This provides more support for your spine and helps take pressure off your nerves. The procedure can take up to 4 hours. You'll have general anaesthesia, and you will need to stay in the hospital for 2-3 days. It may take several months for you to fully heal.

  • Sciatica Treatment Side Effects

    Most nonsurgical sciatica treatments don't have side effects. If you take medicine, side effects are always possible.

    • Over-the-counter pain relievers can sometimes cause stomach upset. Prescription medications often have side effects, but not everyone will have them.
    • Anti-seizure medications might cause dizziness, drowsiness, confusion, or swelling in the feet and legs. 
    • Muscle relaxants can cause drowsiness, dizziness, dry mouth, nausea, and headache. 
    • Steroid injections can make you feel sore around the injection site or cause temporary skin thinning and discoloration. Some people also have insomnia, facial flushing, or high blood sugar after steroid treatment. There is a chance of very sharp pain, called a post-injection flare.

    As sciatica surgeries deal with nerve tissue, there’s a small chance of nerve damage. As with most surgeries, it’s also possible that you could get an infection during recovery.

    Sciatica Treatment Complications

    With most sciatica treatments, you won't have any problems.

    Over-the-counter medication can have some complications:

    • Over-the-counter pain relievers are generally safe. In rare cases, taking a lot of ibuprofen for a long time can increase your risk of having a stroke or heart attack.

    • Taking too much acetaminophen can damage your liver.

    Some people shouldn't take these medications because they can interact with some prescription medicines and make certain health conditions worse. Always ask your doctor first if it's safe for you, how much you should take, and for how long.

    Prescription medications tend to pose more of a risk:

    • Anti-seizure medications can damage your liver. They may also slightly raise the risk of having suicidal thoughts and actions.

    • Muscle relaxants can be addictive. Strong prescription pain relievers such as opioids can also be addictive. If you have a history of addiction, you shouldn't take these medicines.

    Complications from surgery

    Like most operations that use general anaesthesia, there’s a chance of blood clots and heart attack during any surgery for sciatica. Other risks include:

    • Infection
    • Damage to your spinal cord or other nerves
    • Reactions to anaesthetics or sedatives
    • Recurrence
    • A lot of bleeding
    • Spinal fluid leak
    • Lower range of motion in your back
    • Less stability in your spine

    Takeaways

    Sciatica is very common. As much as 40% of people in the U.S. have it at some point in their life. Most cases of sciatica will go away within several weeks and shouldn't worry you. If your pain doesn’t improve after a few weeks or if it gets worse, speak with your doctor about treatment options.

    Sciatica Treatment FAQs

    What triggers sciatica? 

    A herniated disk in the spine is one of the most common causes of sciatica, but other factors, such as bad posture, obesity, or pregnancy can also trigger it. In rare cases, a tumour or cyst can cause sciatica.

    How do you get rid of sciatic nerve pain?

    You can usually treat a mild case of sciatica yourself with a combination of heat, ice, over-the-counter pain medication, and stretching and strengthening exercises. For more severe pain, your doctor might recommend physical therapy, steroid injections, or surgery.

    Will sciatica go away on its own?

    Most cases resolve themselves within 4-6 weeks, but if you have more severe symptoms, it might take longer.

    What relaxes the sciatic nerve?

    Stretching, heat, and over-the-counter anti-inflammatories can all help relax the sciatic nerve.

    https://www.webmd.com/back-pain/treatment-for-sciatica

Key Symptoms of Sciatica Pain: How to Recognize and Manage

From ukspinecentre.co.uk

By Caspar Aylott 

Wondering if your lower back and leg pain is sciatica? The key symptoms of sciatica pain include sharp pain, tingling, numbness, and muscle weakness. Read on for a detailed look at each symptom and tips for managing your pain.

Key Takeaways

• Sciatica pain arises from irritation or compression of the sciatic nerve, manifesting as radiating pain from the lower back to the leg.
• Key symptoms include radiating pain, tingling, numbness, and muscle weakness affecting mobility, and severe symptoms necessitate immediate medical attention.
• Effective management involves conservative treatments, such as physical therapy and medications, while severe cases may require injections or surgical interventions.

I feel your pain…

As a consultant spinal surgeon who has seen thousands of patients with sciatica and experienced this debilitating pain myself, I understand the agony it brings. The burning pain, the relentless nerve pain, and the chronic pain that disrupts every aspect of life are all too familiar to me. Whether it’s a mild ache or severe pain that makes even the smallest movement feel like a monumental task, sciatica leaves an indelible mark on one’s daily existence.

But there is hope. With the right knowledge and strategies, it’s possible to manage pain effectively and reclaim your life. From understanding the underlying causes to recognizing when the pain persists and requires medical intervention, this guide aims to equip you with the tools needed to navigate and alleviate sciatica pain.

Discover how to turn your agony into action.

Understanding Sciatica Pain

Sciatica pain refers to discomfort that originates in the lower back or buttock and radiates down the leg, often following the path of the sciatic nerve. This large nerve runs from the lower spine down to the feet, making it one of the most extensive nerves in your body. Sciatic pain occurs when this nerve is irritated or compressed, leading to pain that can range from a mild ache to severe and debilitating discomfort.

The sciatic nerve is essential for transmitting pain signals along its pathway. When it is compressed or irritated, the resulting pain is classified as nerve pain, which can significantly affect one’s quality of life. Sciatica is a symptom indicative of an underlying issue, such as herniated discs or spinal stenosis, rather than a medical condition in itself. Understanding this is crucial for both treating and preventing sciatica effectively, especially when considering the role of the nerve root.

While many individuals recover from sciatica within a few months, others may experience ongoing symptoms for a longer period. Chronic sciatica is defined as pain persisting for more than eight weeks or recurring intermittently over months or years. The pain characteristics are diverse, often including burning pain, shooting pain, or even a mild ache. Early recognition and appropriate treatment can significantly improve the management and alleviation of sciatica pain. If you’re wondering how long does sciatica last, it’s important to consult a healthcare professional for personalized advice.

Recognizing Sciatica Symptoms

The primary symptom of sciatica is pain along the sciatic nerve path, typically radiating from the lower back through the buttock and down one leg. This pain can manifest in various forms, from intense shooting or searing pain to a dull ache. It often includes tingling or numbness along the affected nerve pathway, impacting daily activities and overall quality of life. Sciatica typically affects only one side of the body.

Sciatica pain can be exacerbated by actions like coughing, sneezing, or lifting the legs while lying down. Additionally, movements such as bending or sitting for long periods often increase the pain. Associated symptoms may include leg pain, numbness and weakness, which can affect movement and stability. Understanding how sciatica occur is the first step in seeking appropriate treatment.

Delving deeper into specific symptoms helps in better recognition and addressing them.

Radiating Pain

Radiating pain is one of the hallmark symptoms of sciatica. This pain typically starts in the lower back and travels through:

• the buttock
• the thigh
• sometimes even the calf and foot The trajectory of the pain usually follows the sciatic nerve path, making it a distinctive and recognizable symptom.

The sensation can vary from a sharp, shooting pain to a burning pain that feels like an electric shock. This type of pain often intensifies with movements that involve stretching the nerve, such as standing up or bending over. This pattern helps in diagnosing sciatica and differentiating it from other types of back pain, which can sometimes lead to worse pain.

Tingling and Numbness

Tingling and numbness are common neurological symptoms of sciatica. Many individuals describe this sensation as similar to the feeling when a limb ‘falls asleep’. This tingling, often described as ‘pins and needles’, often extends down the leg, affecting the toes and creating a sensation that can be both uncomfortable and alarming.

Numbness along the sciatic nerve pathway can significantly impact daily life, making it difficult to perform routine tasks. These symptoms are a direct result of nerve compression or irritation and can signal more severe nerve damage if left untreated.

Early intervention can prevent further complications and aid in effective management.

Muscle Weakness

Muscle weakness is another critical symptom of sciatica. This weakness typically occurs in the leg affected by the sciatic nerve, leading to difficulty in movement and maintaining proper posture. The resulting instability can increase the risk of falls and make walking a challenging task.

Individuals may also experience fatigue and cramping in the affected leg, further complicating mobility. Recognizing muscle weakness and its impact on daily activities is crucial for seeking treatment and preventing further deterioration.

Identifying Severe Symptoms

While many sciatica symptoms can be managed with conservative treatments, certain severe symptoms require immediate medical attention. These include sudden numbness or weakness in the legs, which can indicate significant nerve damage. Difficulty controlling bladder or bowel function is another red flag that should prompt urgent care.

If both sides of the body are affected or if there is severe weakness or numbness in both legs, immediate medical intervention is necessary. These severe cases can lead to significant muscle weakness, affecting leg swelling and requiring prompt evaluation and treatment.

Ignoring these symptoms can result in permanent damage, so seek help without delay.

Common Causes of Sciatica

Understanding the common causes of sciatica can help in both prevention and treatment. Herniated discs and spinal stenosis are among the most frequent culprits, causing nerve compression that leads to sciatica pain. A common cause of sciatica is a lumbar herniated disc, which occurs when the soft center of a spinal disc protrudes through a tear and presses on nerve roots. These conditions create pressure on the sciatic nerve, resulting in the characteristic pain and discomfort.

Piriformis syndrome is another cause, where the piriformis muscle irritates the sciatic nerve, contributing to sciatica. Other common causes of sciatica include degenerative disc disease and spinal stenosis, which can narrow the spaces around the spinal cord. Factors like inflammation, muscle spasms, and chronic sitting can also play a role in developing sciatica. Identifying these causes can guide effective treatment and preventive measures.

Diagnosing Sciatica

Diagnosing sciatica involves a combination of:

• Medical history: helps identify risk factors and symptoms
• Clinical examinations: assess nerve function and pain response
• Imaging techniques: such as MRI scans, which are particularly effective for visualizing herniated discs that might be compressing the sciatic nerve. A physical examination will often focus on assessing the range of motion, muscle strength, and reflexes. Additionally, healthcare providers may diagnose sciatica based on these assessments.

CT scans provide detailed 360-degree images of the spine, revealing conditions that cause sciatica. X-rays can identify bone spurs or tumors affecting the sciatic nerve, while electromyography (EMG) assesses muscle response and nerve activity to pinpoint nerve damage related to sciatica. Specific tests can help identify the exact source of nerve compression during diagnosis.

These diagnostic tools are crucial for developing an effective appropriate treatment plan.

Treatment Options for Sciatica

There are various treatment options available for sciatica. These include:

• Self-care measures
• Conservative treatments such as physical therapy, medications, and lifestyle changes designed to alleviate pain and improve function
• More formal medical interventions like injections or surgical interventions in more severe cases

Understanding the full spectrum of treatment options can help patients make informed decisions about their care. Exploring these options in detail can provide better insights, starting with conservative treatments.

Conservative Treatments

Nonsurgical treatments for sciatica encompass several options. These include cold or heat therapy, medications, physical therapy, and acupuncture. Self-treatments can include rest, applying ice or heat, and stretching. Medications that can help alleviate sciatica pain include over-the-counter pain relievers, prescription muscle relaxants, anti-seizure drugs, and antidepressants. Physical therapy focuses on strengthening muscles, improving flexibility, and reducing pressure on the sciatic nerve to help manage pain. Sciatica treated with these methods can provide significant relief.

Self-care measures that can significantly aid in managing sciatica symptoms include:

• Rest
• Lower back stretches
• Ice application
• Maintaining good posture

Conservative treatments aim to provide temporary relief and improve quality of life.

Injections

Corticosteroid injections are commonly used to manage sciatica pain by reducing inflammation. The primary purpose of these injections is to provide temporary relief, allowing patients to engage in physical therapy and other treatments that can address the underlying causes of their pain.

Epidural injections may be recommended for severe pain that has not responded to other treatments. While these injections can provide significant relief, they are typically considered a short-term solution within a comprehensive treatment plan.

Surgical Interventions

Surgery may become necessary for severe cases of sciatica that do not respond to conservative methods to manage pain. Common surgical procedures for sciatica include discectomy and laminectomy, which aim to relieve pressure on the sciatic nerve. Surgery is usually not recommended unless symptoms indicate nerve damage is occurring or imminent.

Spinal decompression surgery may alleviate nerve pressure and is sometimes accompanied by lumbar fusion to enhance spine stability. The primary goal of these surgical interventions is to relieve pain, numbness, and weakness associated with lumbar radiculopathy, thereby improving the patient’s quality of life.

Managing Sciatica Pain at Home

Managing sciatica pain at home involves practical strategies and lifestyle adjustments. Using alternating hot and cold packs can be effective in managing ongoing pain. Over-the-counter pain relievers like ibuprofen or naproxen may help alleviate discomfort.

Maintaining proper posture while sitting and standing can contribute positively to managing sciatica. Gentle exercise and stretches, along with good posture habits, can prevent sciatica from worsening and promote overall spinal health.

Preventing Sciatica

Preventing sciatica involves a proactive approach to spinal health. Core muscles strength is vital for spinal stability; exercises targeting the abdominal, back, and pelvic muscles are beneficial. Engaging in a variety of exercises like aerobic, strength training, and flexibility workouts can help lower the risk of sciatica.

Maintaining a good posture can help not only in preventing new pain but also in alleviating existing discomfort. Avoiding prolonged sitting, taking frequent breaks, and using standing desks can reduce the risk of developing sciatica.

When to Seek Medical Help

Seek immediate medical attention if you experience:

• Significant leg weakness
• Loss of sensation
• Sudden bowel or bladder function
• Sudden lower back pain
• Sciatica pain that does not improve after conservative treatment

If symptoms persist beyond three days or if experiencing severe pain, genital numbness, or difficulty urinating, consult a doctor. Timely medical intervention can prevent complications and promote recovery.

Summary

Recognizing and managing sciatica starts with understanding its symptoms and underlying causes. From conservative treatments to surgical interventions, knowing your options can empower you to take control of your pain. Implementing preventive measures can reduce the risk of future flare-ups and improve overall spinal health.

Remember, seeking timely medical help for severe symptoms is crucial to prevent lasting damage. Take the first step towards a pain-free life by staying informed and proactive in managing your sciatica.

Frequently Asked Questions

What is sciatica pain?

Sciatica pain is discomfort that begins in the lower back or buttock and radiates down the leg, typically resulting from irritation or compression of the sciatic nerve.

What are common symptoms of sciatica?

Common symptoms of sciatica encompass radiating pain from the lower back down one leg, accompanied by tingling, numbness, and potential muscle weakness in the affected leg. It is essential to recognize these signs for timely intervention.

What causes sciatica?

Sciatica is primarily caused by conditions such as herniated discs, spinal stenosis, and piriformis syndrome, which compress or irritate the sciatic nerve. Identifying the underlying cause is essential for effective treatment.

How is sciatica diagnosed?

Sciatica is diagnosed through a detailed medical history, physical examination, and imaging tests like MRI, CT scans, or X-rays to determine the root cause. Accurate diagnosis is essential for effective treatment.

When should I seek medical help for sciatica?

You should seek medical help for sciatica if you experience significant leg weakness, loss of sensation, sudden bowel or bladder incontinence, or if symptoms persist beyond a few days despite conservative treatment. Prompt medical attention is crucial in these situations.

https://ukspinecentre.co.uk/key-symptoms-of-sciatica-pain-how-to-recognize-and-manage/

4 Encouraging Facts About Sciatica Pain

From virginiaips.com

Are you dealing with the shooting pain and other discomfort sciatica brings? The team at Interventional Pain and Regenerative Medicine Specialists in Arlington, Virginia, wants to help. 

Sciatic neuritis describes the pain you experience when your sciatic nerve gets compressed. Most people call this “sciatica.” The sciatic nerve runs from your lower back, across your hips and buttocks, and down your legs. 

Conditions that affect your spine often trigger sciatica. Some of the most common include:

• Spinal infection
• Spinal inflammation
• Herniated discs
• Spinal stenosis
• Spondylolisthesis

You can also experience sciatica when you’re pregnant or as your body experiences the normal wear and tear related to aging. 

Sciatica pain usually starts in your low back or buttocks and goes down the back of one of your legs. It can feel like a stabbing, shooting, or dull, achy pain. And it often gets worse with long periods of sitting or with walking. 

Our specialists at Interventional Pain and Regenerative Medicine Specialists, Dr. John Huffman and Dr. Talal Ghazal, offer different therapeutic approaches to treat sciatica so you can find relief. Our team begins with accurately diagnosing the cause of your pain so you get effective help. 

We also want you to know that while sciatica may be a literal pain in the buttocks, it’s not all doom and gloom. Here’s a look at four encouraging facts about sciatica pain and how our team can help you put the pain of this frustrating condition behind you.

1. Sciatica is rarely serious

There’s no doubt sciatica can cause a serious disruption to your everyday life. From affecting your ability to sit at work to slowing you down during your day-to-day errands, sciatica is a real pain in the behind. But the good news is that this condition is rarely a serious medical threat.

The most common cause of sciatica is a herniated disc. Your spinal discs cushion the space between each vertebra in your spine. They have a soft, gel-like centre and rubbery exterior. 

As you get older or after an injury, these discs can break down. This degeneration makes them more likely to tear, rupture, or bulge out of place. This is called a herniated disc. It can narrow the spinal canal and put pressure on the sciatic nerve.

The good news is that your body can heal a herniated disc on its own. It typically takes about six weeks. Once the herniated disc is better, your sciatica symptoms also improve. Schedule an appointment to learn how Dr. Huffman and Dr. Ghazal can help you recover faster and with less pain. 

2. Moving can help you heal

Even though sciatica symptoms can make you feel like lying still, sitting too much can actually make sciatica worse. This is good news, however, because it means that by gently exercising your body, you can improve your sciatic neuritis. 

The team at Interventional Pain and Regenerative Medicine Specialists can give you customized exercise recommendations. But in general, low-impact exercises like swimming and walking help promote blood flow and encourage healing. 

3. You probably don’t need medication

It might be tempting to reach for over-the-counter (OTC) pain medications or ask for prescription pain drugs to help you manage sciatica pain. But research shows drugs and medications aren’t usually the answer to sciatica. 

Instead, other treatments, like physical therapy, hot and cold therapy, massage, and modalities that address the underlying compression work better at easing sciatica pain. And these therapies don’t come with the unpleasant side effects many drugs and medications do. 

4. Sciatica typically responds well to treatment

You’ll be happy to learn that most people who have sciatica get better. This is because the condition responds well to treatment. Having an accurate diagnosis is key. 

This is because different conditions can trigger sciatica. And there are other conditions that mimic sciatica, like piriformis syndrome. You may require a different treatment approach based on the cause of your pain. 

https://www.virginiaips.com/blog/4-encouraging-facts-about-sciatica-pain

Steve's Spine Surgery Story

From massgeneralbrigham.org

For months, 57-year-old Steve Bricker lived with unrelenting pain.

The source was a synovial cyst located near his spine. This fluid-filled sac was pressing against his lower back nerves, sending pain radiating from the lower back to the feet. Over about 14 months, the pain shooting down his right side got more and more intense.

"At its worst, I'd rate the pain as a 9 or 9.5 on a 10-point scale," said Steve, a resident of York, Maine. "The only way I could find relief was to lie flat on my back. Living my life became very, very difficult. It was terrible."

After several failed attempts to treat the sciatica, Steve set out on his own to find a solution. His research led him to Mass General Brigham Spine Care and spine surgeon Pat Bovonratwet, MD, who specializes in minimally invasive and endoscopic spine surgery.

'This is the guy'

When Steve started experiencing pain, a local doctor sent him to physical therapy. It didn't help. Eventually, he had an MRI, which showed a synovial cyst near his spine.

Sometimes a synovial cyst can be drained or ruptured with a needle. In Steve's case, doctors tried twice without success, as the cyst was in a hard-to-reach location. Meanwhile, steroid injections intended to calm inflammation and pain only brought temporary relief.

"I finally asked one of my local surgeons, 'What's next for me?'" Steve recalled. "He said, 'Probably a spinal fusion.' That's when I decided to take matters into my own hands and look at other options."

Following some research on minimally invasive spine surgical options, Steve called Mass General Brigham and was referred to Dr. Bovonratwet.

"I shared his background and bio with my father, who's a retired endocrinologist," Steve said. "He said, 'Steve, you've got to do whatever it takes to have him take care of you. This is the guy.'"

Removing cyst via minimally invasive tubular decompression

With his father's vote of confidence, Steve scheduled an appointment with Dr. Bovonratwet at Mass General Brigham Healthcare Center (Danvers). At the visit, Dr. Bovonratwet reviewed an MRI scan and proposed an approach for removing the synovial cyst: minimally invasive tubular decompression.

With tubular decompression, the surgeon uses specialized instruments to gently separate the muscles near the spine. A small, thin tube, about the size of a nickel, is then placed to provide access to the spine.

Using a surgical microscope for visualization, the surgeon takes out a small portion of the lamina (part of the vertebral bone) to safely access and remove the cyst. The spine's natural stabilizing structures, including the spinous process and interspinous ligament, are preserved. Unlike in traditional open spine surgery, no muscles are stripped or cut.

"Tubular and endoscopic decompressions are contemporary, minimally invasive spine surgical techniques that allow us to relieve nerve compression with minimal disruption to surrounding tissues," Dr. Bovonratwet said.

After that visit, Steve knew he was in good hands. "I saw that Dr. Bovonratwet was a kind, lovely man and a great communicator who explained everything very thoroughly," Steve said.

Why high-volume experience matters

Dr. Bovonratwet, who is on the faculty of Harvard Medical School, performs tubular and endoscopic decompressions at Massachusetts General Hospital, Mass General Outpatient Surgery Center in Danvers, and Salem Hospital. On average, he conducts these procedures three or four times a day.

"The more you do it, the more efficient you become. At a high-volume center like ours, with dedicated expertise in minimally invasive and endoscopic spine surgery, these procedures can often be completed in around 60 to 90 minutes," he said. "We can consistently achieve the goal of decompressing the nerves, giving patients the same durable outcome as an open procedure."

Steve's surgery was scheduled for three months after his consultation with Dr. Bovonratwet. It could not have come soon enough.

Before heading to Florida for the holiday season, Steve had a third steroid injection to address his worsening pain. It delivered only about 24 hours of relief. He spent the final weeks before surgery taking pain medications and lying on his back as often as possible.

Finally, the day of surgery arrived. It was the first spine surgery performed at the Mass General Outpatient Surgery Center in Danvers — and the first spine case performed in a freestanding outpatient surgery center within the Mass General Brigham system. Steve was nervous but eager to proceed.

When he woke up from surgery, Steve no longer felt the severe nerve pain that had plagued him for so long. He dreaded the prospect of getting up to walk. But once he did, that all-too-familiar pain shooting down his right leg didn't return. He went home the same afternoon.

"I wasn't ready to call it a cure, but I felt there was enough change that this was going to go as projected," he said. "I couldn't wait to see how my recovery went."

Enjoying a pain-free life again

Immediately after the operation, Dr. Bovonratwet had told Steve that his nerve was red and inflamed from having the cyst pressing against it for so long—but that it would heal quickly. Indeed, Steve was completely pain-free within a few months.

The minimally invasive techniques that Dr. Bovonratwet employed have helped speed Steve's recovery. Since no muscle was cut, he hasn't required any pain medications beyond Tylenol. And other than avoiding lifting heavy objects, he is as active as he was a couple years ago.

"Everyone on my care team at Mass General Brigham was top-notch. Just wonderful," Steve said. "I can't say enough about Dr. Bovonratwet, his communication skills, and his expertise. I've passed on his name to as many people with similar needs as me as I could."

While stressing that some cases of sciatica will require open surgery, Dr. Bovonratwet hopes to increase awareness about tubular and endoscopic spine surgery.

"A lot of patients still don't know this may be an option for them," he said. "I would love for people to see Steve's story and learn that they may be a candidate for these modern minimally invasive procedures.

"Spine surgery has advanced dramatically over the years. Operations that once required large incisions and a hospital stay can now, in select patients, be performed through an incision the size of a nickel or pencil tip, often allowing patients to return home the same day."

https://www.massgeneralbrigham.org/en/patient-stories/steve-spine-surgery-story