Sciatica is the term given to the pain which is caused by the irritation of the sciatic nerve. Sciatic nerve is one of the largest nerves of the body. It originates caudally to the Cauda equine that is just below the lumbar nerve roots situated at the lower back and it goes to the hip area and the back part of both the legs.

 

Sciatica is the term given to the pain which is caused by the irritation of the sciatic nerve. Sciatic nerve is one of the largest nerves of the body. It originates caudally to the Cauda equine that is just below the lumbar nerve roots situated at the lower back and it goes to the hip area and the back part of both the legs. Sciatic pain is generally unilateral and even bilateral but usually it subsides over a period of 6-10 weeks. Pain generally involves the lower back, buttock area and the upper part of the legs and it may radiate to the knees. Sciatica is a common form of the leg and back pain but is not the diagnosis instead it is the symptom of the underlying disease.

Signs and Symptoms

• Pain from the back to the buttocks and down the backs of the legs
• Lower back pain
• Stiff back
• Foot pain
• Thigh pain
• Numbness or muscle weakness in the legs and thigh along the nerve root distribution in the limb
• There may be associated tingling sensations along the affected nerve root
• There may be bladder and bowel dysfunction which may initially present as difficulty in holding bowel and urinary incontinence
• The pain may be acute or chronic and may be radiating in nature
• There can be unilateral or bilateral motor and/or sensory abnormality
• Shooting pain which makes difficult to stand up
• Difficulty in moving leg
• Progressive weakness in the leg

Causes

• Spinal abscess
• Undue pressure on spinal cord
• Diabetic Neuropathy
• Alcoholism
• Trauma to the spine
• Spinal tumors especially the one which are inside the meninges
• Lumbar canal Stenosis
• Direct injury to the sciatic nerve
• Ankylosing Spondylitis
• Spondylolisthesis
• Piriform muscle spasm may lead to piriformis syndrome which may cause pressure on the sciatic nerve
• Spinal epidural hematoma
• Spinal anesthesia
• Lymphoma
• Sarcoidosis
• Spinal abscess
• Obesity
• Exertion

Diagnosis and Investigations

Diagnosis is based on the clinical symptoms combined with the series of the investigations

• Spinal X-rays – can detect the underlying cause and are helpful in some cases
• Electromyelogram – is used when a nerve root compression is suspected
• CT scan – examines the details of the spinal canal and overlying tissues in the cross sectional views and thus is a better guide to the diagnosis
• MRI (Magnetic Resonance Imaging) – is a technique which uses magnetic field to produce images and so its side effects are very limited. It can produce images of the ligaments and the other soft tissues of the body and can detect if problem is with it.

Treatment and Drugs

Various treatment modalities are available for the treatment of the sciatica

• Anti inflammatory medications like NSAID’s and oral steroids are prescribed in some cases.
• Pain killers are prescribed in conditions having acute pain
• Stretching exercises are also advised in some cases
• Non surgical decompression can be done
• Surgical decompression can be done
• Intradiscal Electrothermoplasty
• Coblation Nucleoplasty
• Physical Therapy is also prescribed in some cases