Sciatica - Definition, Causes , Symptoms, Diagnosis And Treatment.

Definition:
The term Sciatica is used for a condition with symptoms of leg pain and may be tingling and numbness along the path of the sciatic nerve. It originates in the lower back, travels through the hip and buttock down to the back of the leg. It typically affects only one side of the body. This term sciatica describes a symptom rather than a specific disease.

Characteristic symptoms of Sciatica:

Sciatica is characterized by one or more of the following symptoms:

• Pain in the leg which is worse when sitting.
• Pain most often occurs only on one side.
• Burning or tingling sensation down the leg.
• Sometimes the pain may be felt like a jolt or an electric shock.
• Weakness, numbness or difficulty moving the leg or the foot.
• A sharp pain that may sometimes make it difficult to walk or move.
• The symptoms may vary widely depending on the underlying cause leading to sciatica

Causes:
Sciatica is caused by irritation of the nerve roots in the lower lumbar and the lumbosacral spine. The conditions that can cause sciatica includes:

• Herniation of the lumbar disc that compresses on one of the lumbar or sacral nerve roots
• Spinal stenosis
• Pelvic injury or fracture
• Pregnancy when the weight of the fetus compresses the sciatic nerve
• Tumors that may impinge on the spinal cord or the nerve roots
• Piriform syndrome- a condition in which the piriform muscle in the buttock region becomes tight and causes irritation of the sciatic nerve.
• Trauma to the spine irritating the nerve roots.
• Bone spurs on the spine

Diagnosis:
A complete history and a physical examination helps in the diagnosis and determining the underlying cause of sciatica.

1. Straight leg raise test: In this test the patient lies on the back with the legs straight. The doctor will then slowly raises each leg and notice the pain which the patient feels with the elevation of the leg. This tests helps in pinpointing the affected nerves and showing any problem with the discs.

2. X-rays to look for any fractures of the spine

3. MRI or CT scan can give more detailed image of the spine and can help with the diagnosis of lumbar disc herniation

4. Nerve conduction studies to determine the electrical impulses along the sciatic nerve.

Management:As sciatica is a symptom rather than a medical condition the underlying problem is to be identified and then treated accordingly. The main goal is to decrease the pain and increase the mobility.

1. General measures: Over the counter pain medicines and anti inflammatory drugs may help decrease the pain and the stiffness. A physical therapy that helps reducing pressure on the sciatic nerve also improves the symptoms.

2. Muscle relaxants: Drugs like cyclobenzaprine may be prescribed to reduce the pain associated with severe muscle spasms.

3. Spinal injections: Patients with severe pain may get benefit from corticosteroid injections in the lower back that helps reduce inflammation of the nerve roots and thus decreases pain and improves mobility

4. Surgery: May be needed for patients who do not respond to conservative treatment.