Anatomy of the Lumbar Spine

The spinal column consists of circular bones called vertebral bodies.  These are separated by intervertebral discs that are made of cartilage..  The spinal cord runs through this column and gives off branches (nerve roots) between the vertebral bodies.  These nerve roots then join together to form the three major nerves that supply sensation to the lower leg.  

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Causes of Leg Pain

‘Sciatica’ is the medical term for pain that goes down into the leg and foot.  Pain that is mainly localised to the leg it is called "leg dominant pain."

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This pain is caused by pressure or inflammation of the nerve roots.  (See illustrations and MRI scan below.)  These might be: 

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• Pressure from a prolapsed or "slipped"intervertebral disc.  

• Pressure from the narrowed spaces where the nerve roots come out of the spine  (foraminal stenosis).

• Inflammation from  the leakage of fluid from an intervertebral disc.

• Pressure from a broken or crushed vertebral body caused by either  trauma or osteoporosis.

• Pressure and inflammation from either an infection or cancer.

The symptoms of Leg Pain

• Pain running down the lower limb.  

• Weakness of the lower leg muscles and foot.  

• Numbness of the skin of the lower leg and foot.

• Pins and needles (paraesthesiae)

• Impotence

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• Loss of bladder and bowel sensation.  This is a serious symptom.  A patient must seek immediate medical advice from a doctor or suitable medical facility.

The treatment of Leg Pain and Sciatica

See PDF Treatment Options Chart

Medications for musculoskeletal pain   

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Paracetamol 500mgs tablets or capsules.  These can be bought over the counter.

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Opioid drugs

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These are potentially habit forming and can have distressing side effects. Their use is usually discouraged and these should not be used in the long-term.

Codeine 

Tramadol

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Morphine

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Buprenorphine patches

Fentanyl patches

Non-steroidal anti-inflammatory drugs (NSAIDs)

ibuprofen, naproxen).

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Medications for nerve or "neuropathic" pain

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amitriptyline, gabapentin, and pregabalin).

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Complementary and physical therapies:

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• Physiotherapy

• Regular exercise (such as walking, cycling and stretching)

• Topical therapies such as anti-inflammatory rubs or gels (Voltarol Emulgel, Mobilat, Ibulieve) and hot or cold pads.

• A TENs Machine

• Acupuncture

• Joint supplements (Glucosamine)

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2.         Interventional therapies:     

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These involve injection therapies and surgical operations. 

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Nerve root block injections (Transforaminal epidural steroid injection.)  

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•   This involves using X-rays to inject local anaesthetic and cortisone (steroids) around the affected nerve root.  (See X-ray image and diagram below.)  This would treat the symptoms (therapeutic intention) and identify the source of the problem (diagnostic intention).  

Lumbar epidural steroid injection:  

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• This is an injection of local anaesthetic and cortisone (steroids) around the nerve roots in the epidural space as they travel down through the spinal canal.

• Surgery to remove the prolapsed disc: 

  • There are various operations that might be carried out. The intention would be either to remove the prolapsed disc or relieve the narrowing caused by the ‘wear and tear’ process.  The precise operation and technique of the surgery would be explained to the patient by the operating surgeon.