Sciatica
Sciatica is a chronic pain conditions in which the patient have pain in low back and buttock radiating down to the leg and toes. The pain is occurring due to inflammation in the sciatic nerve which is thickest nerve of the body and runs from back of the buttock till the leg. Usually the pain will be on one leg only but rarely there can be pain in both the legs. There is nerve compression or pinching occurring due to herniated disc or any bony spur compressing the nerve or due to spinal canal stenosis. The pain is dull aching pain or a shooting kind of pain may or may not be associated with tingling and numbness.
Symptoms
Patient will have a radiating pain from buttock to back of the leg. There will be continuous pain along the nerve path. The pain is dull aching or throbbing or may be like electric shock like which may or may not be associated with features like tingling and numbness in the leg or foot. The pain will initially be mild and then slowly can become severe which will increase on walking. Patients with RED FLAGS (weakness of the leg or having urinary and bowel incontinence) are candidates for immediate surgery. The pain increases on walking and standing and subsides on resting or sitting.
Risk factors
Like old age, obesity, heavy physical activity, prolonged sitting.
Causes
Several spinal disorders can trigger this condition. Medical conditions that may cause sciatica include:
- Herniated lumbar disc (a condition in which the inner portion of the spinal disc protrude through the outer ring)
- Lumbar spinal stenosis (an abnormal narrowing of the lower spinal canal )
- Spondylolisthesis (a spinal condition in which one of the lower vertebrae slides forward onto the bone beneath it)
- Lumbar degenerative disc disease
- Piriformis syndrome (a neuromuscular disorder develops when the piriformis muscle irritates the sciatic nerve)
- Spinal tumor
- Osteoarthritis
- Bone spur (overgrowth of bone)
How to diagnose this condition
Maintaining a good body posture, regular exercises, drinking adequate water, avoid smoking are few preventive measures.
How can we prevent this condition?
Clinical history and examination done by the physician to elicit the cause of pain.
Straight leg raising test is done which is usually sensitive but not very specific. Other tests like heel walking and toe walking is checked for any weakness of the legs, temperature and sensations are checked on both the sides.
MRI of spine is done to identify the herniated disc and nerve compression, spinal canal diameter, spinal canal stenosis, and is considered the gold standard for diagnosis of herniated disc.
X-Ray of the spine can also be done to identify any bony over growth compressing the nerve but it does not help much in diagnosis.