Sciatica: Treatment, symptoms, advice and help
Sciatica is a condition in which the patient feels low back pain in the distribution of the lumbar or sacral roots caused by general compression and/or irritation of one of five spinal nerve roots that give rise to the sciatic nerve.
Incidence, age and sex of sciatica:
Low back pain (LBP) affects approximately 60–85% of adults during some point in their lives but most cases resolve spontaneously. Chronic low back pain, (persisting beyond 3 months) affects an estimated 15–45% of the population. MRI imaging in asymptomatic patients over age 60 years reveals disk protrusions in 80% and degenerative spinal stenosis in 20%
Signs & symptoms of sciatica: Diagnosis
The onset may be sudden or gradual. Alternatively repeated episodes of low back pain may precede sciatica by months or years. Constant aching pain is felt in the lumbar region and may radiate to the buttock, back of thigh, calf and foot. Pain is exacerbated by coughing or straining but may be relieved by lying flat. MRI is the investigation of choice for diagnosis, since soft tissues are well imaged.
Causes and prevention of Sciatica
It is often due to disc protrusion pressing on one of the sciatic nerve roots. , but can be a feature of other rare but important disorders including spinal tumour, malignant disease in the pelvis and tuberculosis of the vertebral bodies. Acute lumbar disc herniation is often precipitated by trauma, usually by lifting heavy weights while the spine is flexed. The aging process is said to be the strongest risk factor for bony degeneration, Genetic factors likely influence the formation of osteophytes and disk degeneration.
The main complications are due to impingement on the nerve roots causing severe radiating pain down the back and sometimes loss of control over passage of urine and stools.
Some 90% of patients with sciatica recover following conservative treatment with analgesia and early mobilization; bed rest does not help recovery. The patient should be instructed in back strengthening exercises and advised to avoid physical manoeuvres likely to strain the lumbar spine. Injection of local anaesthetic or corticosteroids may be useful adjunctive treatment. Surgery may have to be considered if there is no response to conservative treatment or if progressive neurological deficits develop. Central disc prolapse with bilateral symptoms and signs and disturbance of sphincter function requires urgent surgical decompression.