Sciatica is the term used to describe mild to intense pain in the lower limb. The term sciatica does not denote any disease. It is in fact a vague expression for a set of symptoms.
An equivalent medical term is radiculopathy. It is used to describe pain, numbness, tingling, and weakness in the arms or legs caused by a nerve root problem. If the nerve problem is in the neck, it is called a cervical radiculopathy. Since sciatica affects the low back, it is called a lumbar radiculopathy.
The pain is almost always caused by compression/or irritation of either nerve root(s) that form the sciatic nerve.
The pain can also occur due to compression of the sciatic nerve itself.
The area where the pain is felt can include back, buttock, the leg and foot.
The additional symptoms may include be numbness, muscular weakness, pins and needles or tingling sensations. The symptoms are restricted to restricted to one limb in most of the cases.
Most common nerve roots involved are L4, L5 or sacral nerves.
As noted before, sciatica is just a set of symptoms. There can be various causes of sciatica and treatment of sciatica varies with the cause.
Various causes of sciatica can be summed as
- Spinal disc herniation
- Lumbar spinal stenosis
- Piriformis syndrome
- Trigger points
- Lumbar Spondylosis
- Spondylolisthesis
- A mass causing compression of nerve roots e.g. tumor
Diagnosis
Because of the many conditions which can compress nerve roots and cause sciatica, treatment and symptoms often differ from patient to patient.
The diagnosis is based on clinical history, physical examination and investigations wherever required.
Depending upon the severity of the symptoms and patient profile, the investigation can be ordered right away or can be postponed while putting patient on symptomatic treatment.
In later cases, usual period of wait is six weeks.If no improvement in symptoms have occurred in six weeks or red flags are present, imaging is appropriate.
Treatment
As stated before the actual treatment would depend on underlying disease. There are different measures applied in general, for treating the symptoms. These measures include:
- Anti-inflammatory medications
- Opoid drugs if severe pain
- Physical therapy / Stretching exercises
- Epidural steroid injections -Provides temporary relief
- Surgery
Note
Surgery speeds resolution of pain. However, two years post-surgery, outcomes are equivalent.
Thus surgical and non-surgical management have, on the average, about the same results if looked after two years. The patient decision has important bearing in modality of treatment.
[...] syndrome is one of the important causes of sciatica. In this neuromuscular disorder, the sciatic nerve is compressed or irritated by the piriformis [...]