A SYMPTOMATIC SCIATICA -1. Acute stage - (i) Rest In bed with boards under the mattress to support the back

A SYMPTOMATIC SCIATICA -1. Acute stage - (i) Rest In bed with boards under the mattress to support the back (ii) Analgesics as required (iii) Heat, (iv) Injection of 2%procaine or of lignocaine into the sciatic nerve or epidural space or tender spots in the sacro-iliac region may give dramatic relief 2. Chronic stage - Management will depend on cause. Conservative management - (a) High sciatica - (I) Injection of tender spots with 5% procalne (ii) Counter-irritation, heat and massage (iii) Epidural injection - 10 ml. of 2% novocaine, followed by 80 to 100 ml. of normal saline, repeated once a week. Many patients wilh sciatica due to extradural adhesions may be benefited by injection of 30 ml. 1%procaine hycfrochloride mixed with 125 mg. hydrocortisone injected into the epidural space. Three injections are given on consecutive or alternate days This should be followed by active and passive exercises carried out to limit of tolerance (b) Low sciatica - Stretching of sciatic nerve, and injection of novocaine into, or as near as possible 10 the sheath of the nerve B. SCEATICA DUE TO HERNiATED INTER VERTEBRAL DISC - 1 Conservative treatmenl - Complete rest in bed In supine position with only one pillow for 3-6 weeks When pain is relieved, plaster jacket to immobilise the lumbar spine completely for 3-6 months.. After this the jacket is removed, and a lumbar corset worn at all Times during the day. 2 Operative treatment -Indcations - (i) Acute and incapacitating -symptom not relieved by rest in bed or even immobilisation Jn plaster jacket. (II) Quick recurrence of symptoms. (Ill) Evidence of large prolapse causing pressure on cauda equina, or clinical evidence of severe root compressions shown by marked motor and sensory changes Operation consists of hemilaminectomy. removal of the protrusion, and curetting out nuclear