Sciatica is pain that spreads along the sciatic nerve..

Sciatica is usually caused by compression of the nerve roots of the lumbar spine, according to Pannochka, an online publication for girls and women from 14 to 35 years old.. net Most common causes: disc pathology, osteophytes, narrowing of the spinal canal (spinal stenosis).

Symptoms include pain radiating from the buttock to the foot.

Diagnosis includes MRI or CT. Electromyography and nerve conduction velocity measurements help clarify the level of injury. Treatment includes symptomatic therapy and sometimes surgery, particularly if there is a neurologic deficit.

Etiology.

Sciatica is usually caused by compression of the nerve roots, usually due to protrusion of the intervertebral disc, bone deformities (osteoarthritic osteophytes, spondylolisthesis). a tumor or abscess in the spinal canal. Compression can occur in the spinal canal or intervertebral foramen.

Nerves can also compress outside the spine, in the pelvic cavity, or in the buttock.. L5-S1, L4-L5, L3-L4 roots are most often affected.

Symptoms.

Pain radiates along the sciatic nerve, most often to the lower buttock and back of the leg below the knee. Usually the pain is burning, shooting, dagger. It can be combined with low back pain or be without it.. Valsalva maneuver may increase pain.

Compression of the roots can cause sensory, motor, or more objective findings - reflex deficits. Herniated L5-S1 disc can cause a decrease in the Achilles reflex, herniated L3-L4 disc - decreased knee reflex Raising the straightened leg by more than 60 ° (sometimes less) can cause pain radiating to the foot.

This is characteristic of sciatica, but pain radiating downward in the elevated limb combined with pain originating in the contralateral leg (overlap syndrome) is more specific for sciatica.

Diagnostics.

Sciatica may be suspected on the basis of a characteristic algic presentation, and examination of sensitivity, muscle strength and reflexes is necessary. If neurologic deficits or symptoms persist for more than 6 weeks, neuroimaging (MRI) and electroneuromyography (if necessary) are necessary.

Structural abnormalities causing sciatica, including spinal stenosis, are well diagnosed by MRI (preferred) or CT. "

This study can help clarify the question of whether there is one level of nerve damage or more, whether there are clinical correlations with the results of MRI (especially before surgery).

Treatment.

In the treatment of acute pain, it is possible to prescribe bed rest for 24-48 hours with the head end of the bed raised by 30 ° (Fowler half-position). In treatment, it is possible to prescribe NSAIDs (for example, diclofenac, lornoxicam) and acetaminophen, adjuvants (tizanidine).

Improvement may also occur with drugs for neuropathic pain, such as gabapentin or other anticonvulsants, or low doses of tricyclic antidepressants. Care must be taken when prescribing sedative medications to older patients, as they increase the risk of falls and arrhythmias.

Muscle spasm may be relieved by tizanidine, heat or cooling, physiotherapy. The prescription of corticosteroils for acute radicular pain is controversial. Epidural corticosteroids may accelerate pain regression, but should probably be used for severe or persistent pain.

The epidural method of administration of glucocorticosteroids provides the local creation of a high concentration of the pharmaceutical preparation, and, accordingly, the minimization of side effects associated with their systemic action. However, the literature data on the effectiveness of glucocorticosteroids with epidural administration are still insufficient and in some cases are contradictory..

The presence of pain with subsequent changes in the habitual motor stereotype can lead to a more or less rapid formation of MTGs, which will contribute to the overall algic picture.. The presence of radicular compression accelerates the formation of MTZ. MTZ treatment is carried out according to the principles described above, with the exception of kinesitherapy, which, with a discogenic role, can cause an increase in discogenic conflict in the spinal canal..

An indication for surgical treatment may be an obvious disc herniation with muscle weakness or progressive neurological deficit, as well as therapy-resistant pain that prevents the professional and social adaptation of an emotionally stable patient, which is not cured within 6 weeks by conservative methods..

An alternative for some patients may be an epidural corticosteroid.

medbe. ru.