SCIATICA

Sciatica refers to pain that radiates along the path of the sciatic nerve, which is a combination of nerve roots arising from the spinal cord and going to the lower limbs. Typically, the pain starts in the buttock and radiates down the back and side of the thigh and calf to a varying degree up to the ankle, foot and possibly toes. This is generally a sign that the disc (annulus) has herniated and is compressing the nerve root on that side. In certain cases the annulus ruptures and some disc material sequestrates out and presses on one or several nerve roots going down the leg.

 

Generally sciatica affects one lower limb, but when it is bi-lateral (affecting both lower limbs), it is a more serious condition requiring immediate medical attention especially if accompanied by bowel/bladder dysfunction.

 

Sciatica can result from a prolapsed/herniated lumbar disc or be a symptom of lumbar canal stenosis. Sacroiliac joint pain may also cause sciatica (leg pain extending to varying degrees).  

 

Other causes of sciatica can be compression of the nerve by a tumour, Tuberculosis of the Spine, lumbo-sacral fractures, injury to the pelvis or sciatic nerve, post- pelvic radiation affecting the sciatic nerve and diabetic neuropathy. 

 
SYMPTOMS
  • The pain starts in the buttock and radiates down the back and side of the thigh and calf to a varying degree up to the ankle, foot and possibly toes. The pain has been described as sharp, burning, or like electric shock. Coughing, sneezing, bending, walking, prolonged sitting or even standing, can aggravate the pain.

  • Generally sciatica affects one lower limb, but when it is bi-lateral (affecting both lower limbs), it is a more serious condition requiring immediate medical attention especially if accompanied by bowel/bladder dysfunction.

  • Pain may be accompanied by numbness and/or tingling (paraesthesia). Muscle weakness has to be looked for, by the doctor, and can affect just the big toe, the foot (dorsiflexion/plantaflexion) or, unusually, the muscles of the knee. Patient can test for weakness by walking on the heels and toes. Inability to do so could be a sign of foot weakness.

  • Loss of bowel or bladder function as a result of this condition has to be treated as an emergency.

 

 

INVESTIGATIONS
  1. MRI of the lumbar spine shows the spinal cord, the nerve roots arising from it, the vertebra and the discs. MRI shows the degree of degeneration of the disc, the extent of disc herniation and the degree of nerve root compression. Though several discs may show abnormality on MRI the surgeon decides which of the discs is causing the problem and treats accordingly.

  2. X-Ray of the lumbar spine shows the vertebra and there alignment. Most commonly this is done in flexion and extension to check for any instability (listhesis).

  3. CT scan of the spine is done in certain cases where after MRI and X-ray some more information is required by the surgeon. This is particularly relevant in traumatic disc prolapse to look at associated injuries. 

  4. EMG / NCV of the limbs is done in certain cases where the diagnosis is in doubt to rule out conditions like neuropathy that may be from diabetes or certain vitamin deficiencies.

TREATMENT OPTIONS

Although the pain associated with sciatica can be severe, most cases resolve with non-operative treatments in a few weeks. People who have severe sciatica that is associated with significant leg weakness or bowel or bladder changes might be candidates for early surgery.

 

  1. Physiotherapy - While the symptoms are mainly confined to the back the treatment is generally conservative (non-surgical). This includes physiotherapy and analgesia. Bed rest is not recommended beyond 24 to 48 hours at the most. 

  2. Surgical Management - Patients who have significant persistant leg pain (beyong 4-6 weeks) need to be treated surgically through Minimal invasive Spine surgery (link to page 1- treatment options).  This can involve:

 
 
 

Disclaimer : The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only.

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