SciaticaSciaticaPresented By:

Fahad H. Al Hulaibi

King Faisal University

2011

Definition

• Sciatica is pain in the lower extremity resulting from irritation of the sciatic nerve. The pain of sciatica is typically felt from the low back (lumbar area) to behind the thigh and radiating down below the knee & may reach the foot .

Etiology

1)Disc herniation : may occur in different levels

of lumbosacral vertebrae , but the most common are L5 or S1 .

Risk Factors

2) Spinal stenosis:

is a narrowing within the vertebrae of the spinal column that results in too much pressure on the spinal cord . The most common causes of spinal stenosis are related to the aging process in the spine

3) Spondylolisthesis :

degenerative cause of spinal stenosis which is anterior or posterior displacement of vertebra .

• 4) other causes : include irritation of the nerve from adjacent

bone, tumors, muscle, internal bleeding, infections, injury, and other causes. Sometimes sciatica can occur because of irritation of the sciatic nerve during pregnancy.

Clinical pictures

1- pain:

The most common symptom from sciatica. Most people describe a deep, severe pain that starts low on one side of the back and then shoots down the buttock and the leg with certain movements.

• In most people, the pain is made worse by sneezing, coughing, laughing, or a hard bowel movement. Bending backward can also make the pain worse.

• You may also notice a weakness of the leg or foot, along with the pain. The weakness may become so bad patient can't move his foot.

2- Numbness.

3. Walking difficulty.

Examination• The physical examination

of sciatic patients should include:

observation, palpation, determination of the range of motion of the spine, a root tension test and evaluation of the neurological status of the lower limbs .

• straight leg raising test “Lasègue sign“ :

stretches the L5 and S1 roots, and this test is regarded positive if leg pain is aggravated when the affected leg.

• testing of dorsiflexion strength of the ankle and the big toe, with weakness suggesting:

mainly L5 dysfunction.

• testing of ankle reflexes to evaluate :

S1 root dysfunction .

• testing of light touch sensation in the medial (L4), dorsal (L5) and lateral (S1) aspects of the toe .

Investigation• The most helpful

investigation is MRI.

• Also we can use CT scan .

• X ray to see losing of normal lardosis.

Treatment1- medical: if there is no Neuro defect.• Sciatica Pain Relief

Pain is best treated with a non-steroidal anti-inflammatory drugs (NSAID) such as ibuprofen or codeine (in acute cases).

• Physiotherapy.

• Muscle relaxant.

2- SurgerySome patients with sciatica may find significant relief from surgery. In cases of herniated discs, a surgical procedure called a laminectomy may be performed. In this procedure, a portion of the posterior arch is removed to relieve pressure on pinched nerve tissues.

• In cases of spinal stenosis, the portion of bone that is putting pressure on the sciatic nerve system can be removed.

• Cauda equina syndrome :

is a serious neurologic condition in which there is acute loss of function of the lumbar plexus.

Bilatral scaitica.

References

• Sciatica: Studies of symptoms, genetic factors, and treatment with periradicular infiltration Chapter 2. Review of the literature .

• ^ "sciatica" at Dorland's Medical Dictionary .

• Oliphant, D (2004). "Safety of Spinal Manipulation in the Treatment of Lumbar Disk Herniations: A Systematic Review and Risk Assessment". Journal of manipulative and physiological therapeutics .

Thank you