What is sciatica? Sciatica is a syndrome of pain along the sciatic nerve pathway due to multiple etiologies, causing pain in the lower back, buttocks, posterior thigh, posterior lateral calf, and lateral foot. It is usually divided into two types: radicular sciatica and dry sciatica. Beijing Hospital Pain Center Zhao Ying Etiology of sciatica: 1. Radicular sciatica: the lesion is at the spinal nerve root in the spinal canal. Such as lumbar disc herniation, intraspinal tumor, lumbar spinal stenosis, various spondylitis, spina bifida, spinal tuberculosis, lumbosacral spondylitis, intraspinal hematoma, abscess and intraspinal puncture injury. 2. Dry sciatica: lesions travel outside the spinal canal along the sciatic nerve. Such as sacroiliac arthritis, hip arthritis, hip trauma, pelvic swelling, pelvic inflammatory disease, forceps injury, pear-shaped muscle syndrome and systemic diseases such as diabetes, poisoning and peripheral vascular disease. Clinical manifestations and diagnosis 1. Symptoms: In addition to the following symptoms, there will be many other symptoms of the primary disease. Radicular sciatica: mostly acute or subacute onset. Soreness, stiffness and inflexibility in the low back. The pain radiates along the sciatic nerve from the lower back to one side of the buttock, the outer thigh up to the lateral side of the smashed back. The pain is electric shock-like, knife-like, or burning-like continuous pain, increasing in paroxysms and worsening during sleep, coughing, sneezing, defecation, and other increases in abdominal pressure. The pain is aggravated during sleep, coughing, sneezing, defecation and other increases in abdominal pressure. Dry sciatica: mostly subacute or chronic onset. Pain in the lumbar region is not obvious, mainly below the hip along the sciatic nerve. However, the pain increases when coughing, sneezing, defecation, etc. increase abdominal pressure. Sensory disturbances in the lower leg and lateral foot are obvious. The muscles distal to the sciatic nerve lesion are weak or even mildly atrophied. 2. Signs: In addition to the following signs, there will be many other signs of the primary disease. Radicular sciatica: The patient takes a special pain-reducing position with scoliosis. There is pressure pain and percussion pain in the lumbosacral spine. Straight leg raise test and strengthening test are positive. There is decreased dorsal sensation in the lateral calf foot and decreased or absent knee and Achilles tendon reflexes. Dry sciatica: There is pressure pain along the sciatic nerve at the upper edge of the sciatic foramen, between the sciatic tuberosity and the greater trochanter, in the middle of the s fossa, under the fibular tuberosity and behind the outer ankle. There is decreased sensation in the lateral calf and dorsum of the foot. The Achilles tendon reflex is diminished or absent. It is not difficult to make a diagnosis of sciatica based on history, symptoms and signs. The important thing is to find out the cause of the disease, so a comprehensive examination is often needed, such as blood routine, blood sugar, X-ray, ultrasound, gynecological examination, cerebrospinal fluid examination, etc. If necessary, myelogram, CT, MRI examination is performed. It is also important to distinguish between radicular and dry sciatica. The former pain includes the lumbosacral region, with pressure pain next to the spinal prominence, and the pain increases when the abdominal pressure increases, unlike the latter. Treatment of sciatica The principles of treatment for sciatica are: firstly, the cause of the disease is clearly identified, and treatment is carried out to address the cause. In addition to the treatment of the cause, symptomatic treatment should be carried out, such as rest on a hard bed, paravertebral, epidural and sacral block therapy for radicular sciatica, and sciatic nerve block or nerve block along the painful travel area or painful point block for dry sciatica. Non-narcotic analgesics and vitamin B drugs can be used in combination. At the same time, traction, physical therapy, acupuncture, massage, Chinese medicine, etc. are feasible.