July 1, 2005 Up to 40 million American suffer from sciatica pains, but the condition is often not diagnosed correctly. A new imaging technique uses a specially tuned MRI scan to image nerves and highlight them deep inside tissues. Called Magnetic Resonance Neurography, the new technique promises to diagnose conditions such as sciatica -- in which a compressed nerve in the buttock causes persistent lower-back and leg pain -- in up to 95 percent of cases that were previously undiagnosed.
LOS ANGELES -- Millions of Americans live with back and sciatica pain each day. Medication, therapy, even surgery doesn't help. Now one man's invention may ease your pain.
A car accident threatened to cut Donna Sachs' career short. For two years she lived in pain. Sachs' problem wasn't something she could just wash away. She describes the pain as "intense" saying, "It was like a constant, throbbing, shooting pain that just never subsided."
Neurosurgeon Aaron Filler of the Cedars-Sinai Institute of Spinal Disorders in Los Angeles, is behind the cutting-edge technology that helped Sachs. He developed the Magnetic Resonance Neurography or MRN.
Dr. Filler says, "This is the ability to image nerves inside the human body." MRN is really just an MRI scan finely tuned to highlight nerves -- something that has never been done before. Before the MRN, doctors would not have been able to see this. Sachs says, "You could actually see in the MRN where my problem was. They could actually see the nerve trapping the muscle."
This new nerve imaging technology helped Dr. Filler diagnose Sachs' pain as Piriformis Syndrome. Dr. Filler explains the syndrome as a muscle in the pelvis, called the piriformis muscle, which crosses over the sciatic nerve and goes into chronic spasm and causes buttock and leg pain.
"I would walk around holding my buttocks saying, 'It feels like it's an unhappy nerve,' " says Sachs. But with Dr. Filler's help, Sachs' problem was solved and her life and job continued with no more pain.
Dr. Filler believes the new MRN can diagnose 90 percent to 95 percent of sciatica patients who couldn't be diagnosed by current methods. For more information on the MRN, check out Dr. Filler's new book, Do You Really Need Back Surgery?
A new nerve imaging technology called magnetic resonance neurography does a better job than conventional MRI in diagnosing the cause of sciatica. Sciatica is usually diagnosed through a physical exam and an MRI scan. But of the 1.5 million MRI scans performed each year, only about 20 percent revealed a condition serious enough to be treated surgically.
HOW IT WORKS: Conventional MRI uses radio waves combined with strong magnetic fields to image the soft tissues and organs in the body. Although nerves can sometimes be seen in standard MRI images, the old method has been so unreliable that nerve images have never before played a significant role in diagnosis. MR neurography is capable of generating a detailed image of virtually any nerve in the body. The images are obtained in an MRI scanner, but require special software and hardware upgrades. These images are useful because in most cases, any compression or injury involving a nerve has a distinctive and readily observed appearance.
RESULTS: Following their diagnosis, all patients in the study received treatment to reduce pressure on the nerves and the inflammation: spinal surgery, nerve or muscle surgery, physical therapy and exercise, as well as open MR guided injections. The latter uses a specially designed MRI scanner to guide deep injections of pain medication in the spine, muscles, or near nerves.
WHAT IS SCIATICA: Sciatica is a condition where the sciatic nerve becomes inflamed. The sciatic nerve is the largest nerve in the body, running from the lower spine to down to the back of the knee, where it divides into several branches and continues to the foot. The most common cause of sciatica is a damaged disc in the lower back: the normal cushion between the vertebrae of the spin ruptures, pushing the disc into areas occupied by the nerves. The nerves are pinched or compressed, causing pain.
SCIATICA SYMPTOMS: Common signs of sciatica include:
- A cramping sensation of the thigh
- Shooting pains from the buttock, down the leg
- Tingling, or pins and needles sensations in the legs and thighs
- A burning sensation in the thigh
The American Association of Physicists in Medicine contributed to the information contained in the TV portion of this report.
Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.