A Simple Guide to Sciatica

A Simple Guide to Sciatica
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What is Sciatica?
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Sciatica is the symptom of shooting pain down the leg occurring in the sciatic nerve due to inflammation or pressure on the nerve.

What are the causes of Sciatica?
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Sciatica occur as a result of pressure on the sciatic nerve as a result of:

1.slipped disc- a prolapsed intervertebral disc which slipped out of the ligaments holding it may press against the sciatic nerve especially in the lumbar vertebrae

2.disc degeneration - flattening of the disc due to degeneration allows the discs above and below it to compress the sciatic nerve

3.Spinal stenosis- narrowing of the spinal canal can cause compression on the sciatic and other nerves

4.sacroiliatis - inflammation of the sacroliac joint cause swelling of the bones involved in the joint and may compress the sciatic nerve

5.lumbar facet syndrome-the facet bone like any bone in the body can become inflammed, swells and press against the sciatic nerve.

6.Iliolumbar syndrome- the iliolumbar ligament extends from the spine to the iliac crest when inflammed or swollen due to injury can compress the sciatic nerve

7.piriformis syndrome-the piriformis muscle lies on top of the sciatic nerve at the buttock and if inflammed, swells and press on the sciatic nerve.

8.spinal tumour- any tumour in the spine which is near the sciatic nerve may compress it.

What are the symptoms and signs of Sciatica?
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Symptoms:

1.pain may be a continous dull ache in the leg or a shooting pain down the leg

2.pain is present in the buttocks, posterior thigh, and back of outer side of the leg to ankle

3.Pain is usually but not always relieved by rest(lying flat)

4.Pain is aggravated by
a.spinal movements like flexion
b.exercises
c.straining
d.coughing
e.sneezing

5.pain is worse when sitting

6.weakness, numbness, difficulty in moving the leg

Signs:

1.Patient stands with spine rigid.
Sometimes there may sciatic scoliosis to protect the nerve roots on 1 side.

2.Straight leg raising test(SLR) which is normally up to 90 degrees is restricted

3. superficial paresthesia and sensory loss with or without tendon reflexes loss at knee or ankle and muscle weakness depending on severity and site of nerve root compression

What are the investigations required in Sciatica?
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1.Xrays of spine and pelvis for osteoarthritis, disc lesions, ankylosing spondylosis, or metastatic tumours

2.MRI of lumbar spine

3.Electromyogram and nerve conduction studies may give an an indication of the severity of damage to the nerve and the subsequent prognosis

What is the treatment of Sciatica?
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Conservative treatment:
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1.Bed rest with a hard board below the mattress- straighten the back

2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

3.Muscle relaxant to relax muscles

4.Physiotherapy such as traction, massage or expert manipulation of the vertebrae, shortwave diathermy

5.Wearing a corset to straigthen the back and help the traction of the spinal bones

6.After the initial phase of pain is over , gradual mobilisation and exercises to strenghten the spinal extensor muscles

Surgery:
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If conservative methods fail or the pain is too severe, surgical decompression is then considered:

1.microdiscectomy - insertion of a titanium disc to replace the damaged intervertebral disc

2.laminectomy - traditional surgical removal of the damaged intervertebral disc

Finally treatment of the underlying cause is important

What is the prognosis of Sciatica?
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Prognosis depends on the underlying cause.

Mild inflammation of the muscles, ligaments may recover with conservative methods

More severe inflammation of the nerve due to disc or spinal may become worse with time.

How do you prevent Sciatica?
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Avoidance of postural strain on the back- no high heels, avoid bending the back, keep the back straight

Sleep on a hard mattress

Wear a corset

Exercises to strenghten the back muscles.