Innovative Alternatives for the treatment of sciatic pain

The treatment of sciatic pain has evolved in recent years with the development of new regenerative and intradiscal techniques. These options seek not only to relieve pain, but also to promote the regeneration of the affected tissues and prevent the progression of disc damage.

Regenerative Medicine in the Treatment of Sciatic Pain

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): Stimulates the regeneration of damaged tissue by releasing growth factors.
• Mesenchymal Stem Cells: Promote intervertebral disc repair and reduce inflammation.

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

Intradiscal Techniques for Sciatic Pain Treatment

Intradiscal techniques are aimed at reducing pressure on the nerve root and relieving pain caused by spinal nerve compression. They are divided into chemical techniques and physical techniques.

Chemical Techniques: Injections to Reduce Disc Volume

1. Intradiscal injection of Discogel: An ethanol-based gel that, when introduced into the intervertebral disc, reduces the pressure inside the disc and relieves compression on the nerve root.
   • Advantages: Outpatient procedure, low risk and less aggression to the disc.
   • Disadvantages: Not effective in bulky or calcified hernias.
2. Intradiscal ozone: Injection of ozone into the disc to reduce its volume and improve oxygenation of the surrounding tissues.
   • Advantages: Anti-inflammatory and analgesic effect, minimally invasive technique.
   • Disadvantages: Variable results depending on the type of hernia, does not regenerate the disc.
3. Intradiscal Regenerative Medicine: Use of PRP and stem cells to improve disc regeneration and slow disc degeneration.
   • Advantages: Regenerative potential of the disc, may reduce the need for surgery.
   • Disadvantages: Results still under investigation, high costs.

Physical Techniques: Minimally Invasive Procedures

1. Resadisc Intradiscal Technique: Uses radiofrequency applied inside the disc to reduce its volume and relieve intradiscal pressure.
   • Advantages: Less aggression than conventional discectomy, lower incidence of epidural fibrosis.
   • Disadvantages: Not always effective in bulky hernias.
2. Herniotome: Fragments and aspirates herniated material to reduce intradiscal pressure and relieve sciatica.
   • Advantages: Fast procedure with short recovery.
   • Disadvantages: May need to be repeated if the hernia recurs.
3. Intradiscal radiofrequency: Modulates pain transmission without the need for disc resection.
   • Advantages: Analgesic effect without altering the disc structure.
   • Disadvantages: Does not reduce the size of the hernia.
4. Intradiscal Laser: Uses laser energy to vaporize part of the nucleus pulposus and reduce pressure on the nerve root.
   • Advantages: Minimally invasive technique.
   • Disadvantages: Risk of thermal damage to nearby tissues.

Conclusion

Advances in regenerative medicine and intradiscal techniques offer new options for patients with chronic sciatic pain. These therapies make it possible to treat the cause of the pain with less invasive procedures and with less risk than conventional surgery. The choice of treatment will depend on the type of disc pathology and specialized medical evaluation.

 

Dr. Jorge Orduña
Medical Director MIVI Salud and Doctor in MIVI Valencia