Lumboischialgia can be treated both conservatively and surgically. Conservative therapy is preferred to surgical treatment as long as no neurological deficits or paralysis occur. The conservative therapy of lumboischialgia is based on a multimodal therapy concept.
This means that the therapy consists of different starting points and includes different approaches. These include the
- Drug therapy
- Anaesthesia
- Physical therapy or physiotherapy as well as the
- Back school to increase the back musculature
For the correct choice of medication in lumboischialgia, a thorough physical examination by the doctor is required. In drug-based pain therapy, the recommendations of the World Health Organization are followed.
This is roughly divided into three stages with the option of combining other drugs. One starts with the least potent painkillers, such as ibuprofen, paracetamol or novalgin. The next stage is followed by less potent opioids and the third stage forms strong opioids.
These painkillers can always be combined with drugs such as cortisone, antidepressants or muscle relaxants. In lumboischialgia, for example, cortisone can be given as injections directly near the point where the nerve exits the body. It is important that the pain therapy is adapted to the needs of the patient.
When taking medication at home, it should be ensured that the pain medication is taken at regular intervals as prescribed. In this way a certain level of the medication in the blood is reached and pain peaks are prevented. The drug therapy of lumboischialgia consists of the administration of pain medication (NSAIDs) or muscle relaxants.
In some cases, the non-steroidal anti-inflammatory drugs (NSAIDs) are not sufficient to provide relevant pain relief. In such cases, centrally acting drugs may have to be used, in some cases even morphine. In order not to irritate the stomach while taking pain medication, stomach protection should be taken in any case.
Muscle relaxants are used if the back muscles cramp up due to the relieving posture and lead to additional pain. Another possibility in the treatment of lumboischialgia is the direct injection of local anesthetics and anti-inflammatory drugs. This involves puncturing the site of inflammation with a small needle.
Then the anaesthetic local anaesthetic and the anti-inflammatory medication are injected. The local anesthesia directly relieves the pain. By means of the anti-inflammatory drug the pain can also be treated permanently.
However, the effect of the drugs diminishes again, so that daily injections must be made for effective pain management and causal therapy. As soon as the acute pain symptoms have subsided, physical therapy and physiotherapy are performed to strengthen the back muscles. The physical measures include heat and cold therapy, manual therapy in the sense of massage, lying on a stepped bed and therapy using ultrasound waves.
Bed rest and elevated leg positioning until the symptoms are alleviated are also recommended. In order to prevent a renewed lumboischialgia, the strengthening of the back muscles is recommended. This can be done within the framework of a back school, for example in a fitness studio.
During the training, not only the back muscles should be strengthened, but also the correct posture and movement in everyday life should be learned. In many cases, this can prevent a renewed lumboischialgia. In the case of a cauda syndrome and the occurrence of paralysis (pareses) there is an absolute indication for surgery.
Also in case of incontinence or therapy-resistant pain as a result of lumboischialgia, surgery is recommended. There are different procedures to choose from:
- Microdiscectomy involves the removal of the involved part of the vertebral bone or intervertebral disc. This is done under microsurgical technique, so that no large access path needs to be opened to reach the corresponding intervertebral disc.
The subsequent rehabilitation and healing often proceeds quickly and without further complications.
- Foraminotomy is also a relatively minor procedure, which is performed in the prone position.Only the small part of the protruding tissue (sequester) is removed. The intervertebral disc is preserved and the stability of the vertebral body is not further impaired. Thus, no placeholder has to be inserted instead of the actual intervertebral disc.
However, this procedure is only possible for small disc herniations.
- As soon as a larger part of the disc has slipped into the spinal canal, it must be completely removed (laminectomy). During this procedure, the vertebral arch and its spinous process are removed in order to reach and remove the intervertebral disc. However, the spine loses stability in the process, so that a placeholder or spondylodesis must always be performed.
- For this reason, in some cases only a part of the vertebral body is removed (hemilamectomy) in order to achieve residual stability.
We always try to choose the gentlest and smallest surgical method in order to maintain the stability of the spinal column. In addition, the access route for a laminectomy is significantly greater than for a micoreconstructive operation, since a large incision must be made over the spinal column. In some cases, however, microsurgical surgery is not sufficient to relieve the symptoms of lumboischialgia.