Non-surgical interventional treatments available for the treatment of sciatic pain

Non-surgical interventional treatments available for the treatment of sciatic pain

Currently, there are several non-surgical treatment options to relieve sciatic pain, restore function and prevent its progression. Among them, interventional treatments have shown great effectiveness in cases where conservative management has not been sufficient.

The main available therapies, such as epidural blocks, radiofrequency and intradiscal techniques, are presented below, highlighting their benefits, limitations and clinical applications in the treatment of sciatic pain.

Epidural Blocks

Epidural blocks consist of the administration of local anesthetics and corticosteroids into the epidural space in order to reduce inflammation of the affected nerve root and provide pain relief.

Transforaminal Epidural Blocks:

Epidural blocks can be performed through different approaches: interlaminar, caudal and transforaminal. Of these, the transforaminal epidural block is considered the most selective and effective, since it allows the medication to be administered directly in the affected area, achieving a greater concentration of the drug in the compromised nerve root. Advantages of Transforaminal Epidural Block
o Greater precision in the application of the medication.
o Rapid improvement of pain by reducing radicular inflammation.
o Lower dose of drug compared to interlaminar or caudal approaches.
o Diagnostic use to determine the nerve root responsible for the pain.

This procedure is especially useful in patients with lateralized or foraminal disc herniation, where the radicular compression is more focused.

Pulsed radiofrequency of the dorsal root ganglion associated with transforaminal corticoid.

Mechanism of Action
Pulsed radiofrequency (RFP) is a minimally invasive technique that modulates nerve fiber activity without generating significant thermal injury. Its action is based on the application of pulses of energy in the dorsal root ganglion (DRG), which induces changes in neurotransmitter expression and reduces pain perception without affecting the integrity of the nerve structure.
When combined with a transforaminal epidural block with corticosteroids, the anti-inflammatory effect is enhanced and longer lasting pain relief is achieved.

Cases where it makes a difference
– Patients with persistent radicular pain despite previous epidural blocks.
– Cases of chronic radiculopathy with moderate to severe symptoms.
– Patients with contraindications to surgery or seeking to avoid surgery.
– Situations where neurological modulation is required without nerve ablation.

Studies have shown that pulsed radiofrequency can provide pain relief for up to six months or more, with less risk of side effects compared to other interventional procedures.

3. Epidural Treatments with Regenerative Medicine

In recent years, regenerative medicine has emerged as a promising alternative in the treatment of low back and radicular pain. Among the most widely used options are:

  • Platelet Rich Plasma (PRP): Promotes regeneration of damaged tissue by releasing growth factors.
  • Mesenchymal Stem Cells: Able to differentiate into various cell types and promote the repair of the intervertebral disc.

Epidural application of these treatments aims to reduce inflammation and improve nerve and disc tissue regeneration, although long-term studies are still required to determine their definitive effectiveness.

4. Intradiscal Techniques

Intradiscal techniques aim to relieve pressure on the nerve root and reduce the pain caused by spinal nerve compression that occurs when spinal root compression occurs as we have seen. According to their mechanism of action they are divided into chemical techniques and physical techniques.

Chemical Techniques
They are a treatment option in which thanks to the injection of different substances we can achieve a reduction in the volume of protruded / herniated disc that produces compression of the radicular nerve causing sciatica.

Intradiscal injection of discogel
It is a gel based on ethanol and radiopaque agents that when introduced into the intervertebral disc allows to reduce the pressure inside the disc and thus relieve the compression on the nerve root that produces the hernia. It can allow the resorption of a protrusion or a sical hernia.

Advantages:

  • Low risk outpatient procedure.
  • Less aggression to the disc compared to surgery.

Disadvantages:
– Not effective in cases of bulky or calcified hernias.

2. Intradiscal ozone
Ozone is injected into the intervertebral disc in order to reduce its volume and improve oxygenation of the surrounding tissues.

Advantages:

  • Anti-inflammatory and analgesic effect.
  • Low invasive technique.

Disadvantages:

  • Variable results according to the type of hernia.
  • It does not regenerate the disk.

3. Regenerative Medicine Treatments

They include the use of PRP and stem cells injected inside a disc to improve disc regeneration and delay the stages of degeneration.

Advantages:

  • Regenerative potential of the disc.
  • May reduce the need for surgery.

Disadvantages:

  • Results still under investigation.
  • High costs.

Physical Techniques

They are a treatment option in which using physical agents we can achieve a reduction / removal of the protruded / herniated disc volume that produces compression of the radicular nerve causing sciatica type pain.

1. Resadisc Intradiscal Technique

Mixed system that uses a special type of radiofrequency applied to the interior of the disc that produces a reduction in disc volume and can be associated with the use of a system that extracts part of the contents of the nucleus pulposus, thus reducing intradiscal pressure and therefore sciatica-type pain.

Advantages:

  • Less aggression than a conventional discectomy.
  • Lower incidence of epidural fibrosis

Disadvantages:

  • It may not be effective in bulky hernias.

2. Herniotome

It is a minimally invasive technique that fragments and aspirates the herniated material thus reducing intradiscal pressure and therefore sciatica-like pain.

Advantages: Fast procedure with short recovery time.

Disadvantages: It may be necessary to repeat the procedure if the hernia recurs.

3. Intradiscal Radiofrequency

Application of radiofrequency to the disc to modulate pain transmission.

Advantages: Analgesic effect without the need for disc resection.

Disadvantages: Does not reduce the size of the hernia.

4. Intradiscal Laser Technique

It uses laser energy to vaporize part of the nucleus pulposus and thus decreases the pressure it generates on the nerve root.

Advantages: Minimally invasive.

Disadvantages: Risk of thermal damage to nearby tissues.

 

Conclusion

Interventional treatment of sciatic pain has evolved significantly, allowing patients access to less invasive and highly effective therapies. The selection of the appropriate procedure will depend on the type of disc pathology, the severity of symptoms and the response to previous treatments. With advances in regenerative and intradiscal techniques, there is a promising outlook for the management of low back radicular pain without the need for surgery.