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www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA www.agrasenortho.com!
Dr.Sandeep Agrawal
Consultant Or...
www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA www.agrasenortho.com!
www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA www.agrasenortho.com!
www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA www.agrasenortho.com!
www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA www.agrasenortho.com!
• Conservative treatment
– Alters the natural history ?
• Foraminal epidural steroid injection
– Positive response: more t...
• Bed Rest (80% resolution within 6 weeks),
herniated disc reduced in size over time
( water content loss, inflammatory
cy...
www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA www.agrasenortho.com!
www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA www.agrasenortho.com!
www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA www.agrasenortho.com!
www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA www.agrasenortho.com!
This presentation is for  doctor...
www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA www.agrasenortho.com!
Visit us at:
www.drsandeepagrawa...
Visit us at:
www.drsandeepagrawal.com
www,agrasenortho.com
Exploring sciatica & back pain www.drsandeepagrawal.com www.agrasenortho.com agrasen hospital gondia vidarbha dr sandeep c...
Exploring sciatica & back pain www.drsandeepagrawal.com www.agrasenortho.com agrasen hospital gondia vidarbha dr sandeep c...
Exploring sciatica & back pain www.drsandeepagrawal.com www.agrasenortho.com agrasen hospital gondia vidarbha dr sandeep c...
Exploring sciatica & back pain www.drsandeepagrawal.com www.agrasenortho.com agrasen hospital gondia vidarbha dr sandeep c...
Exploring sciatica & back pain www.drsandeepagrawal.com www.agrasenortho.com agrasen hospital gondia vidarbha dr sandeep c...
Exploring sciatica & back pain www.drsandeepagrawal.com www.agrasenortho.com agrasen hospital gondia vidarbha dr sandeep c...
Exploring sciatica & back pain www.drsandeepagrawal.com www.agrasenortho.com agrasen hospital gondia vidarbha dr sandeep c...
Exploring sciatica & back pain www.drsandeepagrawal.com www.agrasenortho.com agrasen hospital gondia vidarbha dr sandeep c...
Exploring sciatica & back pain www.drsandeepagrawal.com www.agrasenortho.com agrasen hospital gondia vidarbha dr sandeep c...
Exploring sciatica & back pain www.drsandeepagrawal.com www.agrasenortho.com agrasen hospital gondia vidarbha dr sandeep c...
Exploring sciatica & back pain www.drsandeepagrawal.com www.agrasenortho.com agrasen hospital gondia vidarbha dr sandeep c...
Exploring sciatica & back pain www.drsandeepagrawal.com www.agrasenortho.com agrasen hospital gondia vidarbha dr sandeep c...
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Exploring sciatica & back pain www.drsandeepagrawal.com www.agrasenortho.com agrasen hospital gondia vidarbha dr sandeep c agrawal gondia maharashtra

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Sciatica is a condition that occurs when nerve roots are compressed or irritated in the area of the spine located in the lower back. This condition is also called lumbar radiculopathy. Lumbar refers to the area of the spine in which it occurs, while radiculopathy is the word used to describe pain, weakness, tingling and numbness caused by irritation of the nerve roots.
The human spine or back is composed of a complex arrangement of bones, discs, muscles, ligaments and tendons. Each block of bone or vertebrae is separated by a cartlage like structure called a disk. Problems with any of these structures may lead to low back pain. Occasionally the causes of back pain is never found. The following are some of the most common causes of low back pain:
strain – muscles or ligaments

structural problems
herniated or bulging discs
sciatica
arthritis
abnormal curvature
osteoporosis
cauda equina syndrome
cancer of the spine
infection of the spine
shingles
bed mattress
sleeping disorder

every day activities or poor posture
Dr.Sandeep C Agrawal

Consultant Orthopaedic Surgeon

Joint replacement & Spinal surgeon

Complex Trauma Fracture & Revision Surgery Expert

Agrasen Hospital Gondia

Vidarbha Maharashtra India

www.drsandeepagrawal.com

www.agrasenortho.com

Published in: Science
  • The spinal column is one of the most important parts of the body, as it makes many different functions possible, including movement and balance. The spinal column also allows for upright posture, protection of the spinal cord and shock absorption. The spinal column and vertebrae are made of different elements, all of which protect the spinal cord while communicating with the brain. These elements also provide sensations through the body via a complex interaction of the bones, ligaments and muscle structures of the back and the nerves that surround it. Sections The spine is composed of 33 bones, called vertebrae, divided into five sections: the cervical, thoracic, and lumbarspine sections, and the sacrum and coccyx bones. The cervical section of the spine is made up of the top seven vertebrae in the spine, C1 to C7, and is connected to the base of the skull. The top two vertebrae are also know as the atlas and axis, which form the joint for connecting the skull to the spine. The cervical section is responsible for mobility and normal functioning of the neck, as well as protection of the spinal cord, arteries and nerves that travel from the brain to the body. The thoracic section of the spine is located at chest level, between the cervical and lumbar vertebrae. The vertebrae in this section are labeled T1 to T12 and serve as attachments for the rib cage. The lumbar section is located between the thoracic vertebrae and the sacrum. The five lumbar vertebrae, labeled L1 to L5, are the main weight-bearing section of the spinal column. The sacrum is the section located at the base of the spine. It does not have discs separating the vertebrae, because its five levels, S1 to S5, are fused together. The pelvis is connected to the spinal column at the sacrumsection. The coccyx is at the very base of the spinal column and is made of four vertebrae that are fused together. Spinal Curvature Scoliosis The spine is normally a straight line when viewed from the back. If the spine curves to one side or the other, this indicates a condition named scoliosis. However, the spine does have some normal, gradual curves when viewed from the side. The neck and lumbar sections of the spine have a lordotic curve, which means that they curve inward. The thoracic spine has a kyphotic curve, which means that it curves outward. These spinal curves help maintain balance while upright and support the weight of the head and upper body. However, too much curvature may cause spinal imbalance, causing spinal conditions that may result in pain or loss of mobility. Normal adult spines are positioned over the pelvis, so upright posture doesn't strain muscles. However, changes ofspinal position can stress muscles and cause spinal deformity. If the spine is injured and unable to function properly, it can be very painful or even disabling. Parts of the Spine The spine is made of many parts that protect the spinal cord, facilitate movement and support the body. 1 Spinal Cord The spinal cord has nerve pathways that carry signals, such as pain, from the arms, legs, and the body to the brain. 2 Nerve roots Nerve roots are used to transmit information between the spinal cord and the other parts of the body, such as arms, legs and organs. 3 Vertebral Body The cylinder-shaped vertebral body is the weight-bearing structure of the vertebrae. 4 Lamina The flat plates of the lamina create the outer wall of the vertebral canal and help protect the spinal cord. 5 Vertebral Canal The spinal cord sits in this channel formed by the lamina and the vertebral body. 6 Pedicles Pedicles connect the lamina to the vertebral body. 7 Discs Discs separate the vertebrae. They are made of tough, elastic material that allows the spine to bend and twist naturally. 8 Articular Facet The articular facets are where two neighboring vertebrae attach. 9 Spinous Process The spinous process protrudes from the back of each vertebra. Muscles and ligaments that move and stabilize the vertebrae attach to the spinous processes. 10 Transverse Process Two transverse processes stick out of the sides of each vertebra. Muscles and ligaments that move and stabilize the vertebrae attach to the transverse processes. Nervous System All of the above elements of the spinal column and vertebrae protect the spinal cord, which provides communication to the brain. The spinal cord also transmits sensation and mobility in the body through interaction of ligaments, bones and muscle structures of the back and its surrounding nerves. The spinal cord ends at the L1 level, where it divides into many different nerve roots that travel to the lower body and legs. This bunch of nerve roots is called the cauda equina, which means "horse's tail."
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Exploring sciatica & back pain www.drsandeepagrawal.com www.agrasenortho.com agrasen hospital gondia vidarbha dr sandeep c agrawal gondia maharashtra

  1. 1. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA www.agrasenortho.com! Dr.Sandeep Agrawal Consultant Orthopedic Surgeon MS,DNB Agrasen Hospital Gondia Maharashtra India www.agrasenortho.com www.drsandeepagrawal.com drsandeep123@gmail.com 09960122234 EXPLORING SCIATICA (BACK PAIN ) Visit us at: www.drsandeepagrawal.com www,agrasenortho.com
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  6. 6. • Conservative treatment – Alters the natural history ? • Foraminal epidural steroid injection – Positive response: more than 50% leg pain improvement – 3 to 4 times in one year • Absolute indication for surgery – Bladder and bowel symptoms – Progressive neurologic deficit • Relative indication for surgery – Intractable pain more than 6 weeks • Three sciatica episodes -> 100% future episodes • Gold standard: laminotomy + discectomy • Extraforaminal disc: Wiltse paraspinal approach
  7. 7. • Bed Rest (80% resolution within 6 weeks), herniated disc reduced in size over time ( water content loss, inflammatory cytokines reduction) • Medication • Activity modification • Steroid injection => improved symptoms • Chymopapain –Possible anaphylatic shock Lyman Smith, 1963
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  11. 11. www.drsandeepagrawal.com AGRASEN HOSPITAL DR SANDEEP AGRAWAL GONDIA www.agrasenortho.com! This presentation is for  doctors and students in general.! . Graphics,Images and jpeg files are taken from Google and yahoo  Image  to heighten the specific points in this presentation. ! • If there is any objection/or copyright violation, please inform drsandeep123@gmail.com for prompt deletion. ! • It is intended for use only by the doctors of orthopaedic surgery.! . Views expressed in this presentation are personal. • .For any confusion please contact the sole author for clarification. ! • Every body is allowed to copy or download and use the material best suited to him. ! There is no financial involvement.!  • For any correction or suggestion please contact drsandeep123@gmail.com.! Visit us at: www.drsandeepagrawal.com www,agrasenortho.com
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