Sciatica is a pain that radiates from the lower back to the lower extremities and is named for its interference with the sciatic nerve. The sciatic nerve transmits sensations from the lower extremities and low back to the spinal cord. Sciatica mostly heals on its own without surgical management.
Symptoms
Typical symptoms are low back pain radiating to the buttocks and lower extremities, and pain that worsens when bending, coughing, sitting or standing, or sleeping. Sciatica may also be accompanied by numbness and weakness in the lower extremities. Sciatica often comes on suddenly and lasts for several weeks.
Low back pain is a common symptom with a very diverse etiology, the most common cause being spasm of the low back muscles or ligaments. Sciatica is typically characterized by radiation to the lower extremities and even to the feet.
Who is prone to sciatica?
It is mostly seen in middle-aged people, and pregnant women are at a high risk because the lumbar spine carries more weight. Other causes are spinal degeneration and lumbar disc herniation.
Etiology
Lumbar disc herniation: a common cause of sciatica, as age increases the discs are more fragile and more likely to degenerate. The degenerated disc may protrude posteriorly to compress the nerve roots which together form the sciatic nerve.
Spinal stenosis: Degeneration of the vertebral body can cause narrowing of the spinal canal, which can cause compression of the spinal cord or nerve roots, and sciatica is one of the symptoms of lumbar spinal stenosis.
Spinal tumors: direct compression of nerve roots by spinal tumors can also cause sciatica, but is uncommon.
Pear-shaped muscle syndrome: The pear-shaped muscle located in the buttocks can sometimes also cause irritation to the sciatic nerve, called pear-shaped muscle syndrome.
A wallet in a pants pocket for a long period of time can lead to pear-shaped muscle syndrome and sciatica.
Infection or trauma: Occasionally, sciatica can be caused by trauma, fractures, and infections. All compression or irritation of the sciatic nerve may lead to sciatica. Sometimes the cause may not be accurately detected.
Diagnosis
Examination: The doctor will ask detailed questions about the location of the pain, aggravating and relieving factors, etc. The patient’s lower limbs will be moved in multiple angles during the examination.
Imaging tests: MRI, CT, etc. can help discover the cause of sciatica, and only with an accurate diagnosis can treatment be carried out effectively.
Complications
When sciatica is combined with urinary and fecal disorders, it indicates that the condition is very serious and requires medical attention as soon as possible to decide whether surgical treatment is needed.
Treatment
Home remedies include cold and hot packs, alternating between hot and cold packs for 20 minutes every few hours.
Medications: Commonly used medications include nonsteroidal anti-inflammatory drugs, acetaminophen, etc. Intraspinal glucocorticoid injections are indicated for some patients.
Stretching: Hard beds are no longer as revered as they once were. Rehabilitation physicians can develop a standardized exercise program for patients, and walking can be helpful in relieving symptoms in some patients.
Intralesional glucocorticoid injections: This method provides rapid relief of inflammation around the nerve root.
Surgery: If sciatica does not respond to conservative treatments such as medications and injections, surgical treatment needs to be considered. There are different surgical methods that are determined by the needs of the patient’s different conditions. Sometimes it is necessary to remove part of the disc or bony structure to release the compression of the nerve.
Recurrence prevention
Sciatica can recur. To prevent recurrence, patients need to exercise reasonably and avoid lumbar injuries or rapid bending and heavy lifting, etc.