Navigated spinal surgery offers new hope to UAE residents who have long suffered from sciatica. The new procedure involves scanning the affected area on the operating table and loading it on to a camera-linked computer, which in turn interacts with a patient tracker and the instruments used in surgery. It gives the surgeon a real-time image of where his instruments and implants are within the patient.
Dr Nicholas Thomas, Consultant Neurosurgeon at King’s College Hospital London and the Harley Street Clinic in London, explains. “There are several potential merits to navigated spinal surgery — reduced radiation exposure, intraoperative imaging, and reduced operative time. All this is beneficial to the patient,” he says.
Dr Thomas cites the success rate among UAE patients, including a man who underwent the procedure at King’s College Hospital in London after diagnosis from its medical centre in Abu Dhabi’s Khalidiyah. Crippled with sciatic pain, he had tight compression of the nerve root and could not walk further than ten steps. Aiming not just to preserve the function he had left, but also to improve it, the procedure of lumbar decompression and fusion lasted over an hour.
The patient walked out of the hospital a few days later with significantly improved movement and vast reduction in pain.
There are various treatment options for sciatica, including pain relief, physiotherapy, epidural or nerve root injection, surgical decompression, microscopic neurosurgery, and endoscopic neurosurgery, adds Dr Thomas.
Corroborating the wide choice of treatments for sciatica is Dr Senthil T. Nathan, Specialist Orthopaedic Surgeon at Mediclinic Welcare Hospital.
“Conservative management includes both anti-inflammatory medication and physical therapy. In case physical therapy fails, the next line of management is lumbar epidural steroid injection.”
Dr Nathan, who has a Fellowship in Spine Surgery, says only 5-10 per cent of patients with sciatica require surgery. “Surgical intervention is considered when conservative treatment has failed, radicular pain is associated with weakness of the lower extremities, and the patient is unable to control bladder or bowel movements.”
The most common reason for sciatica is the compression of the nerve at the lumbar spine by a disc protrusion.
“If there is no weakness at the leg-foot (foot drop), initial treatment for most cases is conservative, including medications such as analgesics, anti-inflammatories, muscle relaxants and physiotherapy,” says Dr Nicandro Figueiredo, Spinal Neurosurgeon at Medcare Orthopaedic and Spine Hospital. “If there is no improvement despite the treatment, then surgical procedure can be advised,” he says, “especially if there is no improvement after six weeks of non-operative treatment or if the severity of symptoms prevents the patient from working or daily activities.”
Awareness about sciatica and its treatment is of great – and growing – importance in the UAE. “Due to the high prevalence of diabetes in the UAE, and the increasingly sedentary lifestyles and high body mass indexes, it is possible to estimate there will be an increase in sciatica, and other back-related issues in the country,” cautions Dr Thomas.
Dr Nathan adds that sciatica is not only one of the major contributors for Disability Adjusted Life (DALY) years around the world, but that a recent study has identified the growing prevalence of sciatica in the UAE.
That said, residents can be hopeful, he says. “With the advancement and availability of state-of-the-art facilities here, spine surgery has become a safe treatment option for sciatica in the UAE that is comparable to other centres around the world.”
