Sciatica

Sciatica is a pain affecting the back, hip, and outer side of the leg, caused by compression of a spinal nerve root in the lower back, often owing to degeneration of an intervertebral disc.













Cause[edit]
Spinal disc herniation


Spinal disc herniation pressing on one of the lumbar or sacral nerve roots is the primary cause of sciatica, being present in about 90% of cases.[5]


Sciatica caused by pressure from a disc herniation and swelling of surrounding tissue can spontaneously subside if the tear in the disc heals and the pulposus extrusion and inflammation cease.
Spinal stenosis


Other compressive spinal causes include lumbar spinal stenosis, a condition in which the spinal canal (the spaces the spinal cord runs through) narrows and compresses the spinal cord, cauda equina, or sciatic nerve roots. This narrowing can be caused by bone spurs, spondylolisthesis, inflammation, or herniated disc, which decreases available space for the spinal cord, thus pinching and irritating nerves from the spinal cord that travel to the sciatic nerves.
Piriformis syndrome


Piriformis syndrome is a controversial condition that, depending on the analysis, varies from a "very rare" cause to contributing to up to 8% of low back or buttock pain.[7] In 15% of the population, the sciatic nerve runs through, or under the piriformis muscle rather than beneath it. When the muscle shortens or spasms due to trauma or overuse, it's posited that this causes compression of the sciatic nerve.[7] It has colloquially been referred to as "wallet sciatica" since a wallet carried in a rear hip pocket compresses the buttock muscles and sciatic nerve when the bearer sits down. Piriformis syndrome cause sciatica when the nerve root is normal.[8][9]
Pregnancy


Sciatica may also occur during pregnancy as a result of the weight of the fetus pressing on the sciatic nerve during sitting or during leg spasms. While most cases do not directly harm the fetus or the mother, indirect harm may come from the numbing effect on the legs, which can cause loss of balance and falling. There is no standard treatment for pregnancy induced sciatica.[10]
Other


Sciatica can also be caused by tumours impinging on the spinal cord or the nerve roots.[5] Severe back pain extending to the hips and feet, loss of bladder or bowel control, or muscle weakness may result from spinal tumours or cauda equina syndrome. Trauma to the spine, such as from a car accident, may also lead to sciatica




Diagnosis


Sciatica is typically diagnosed by physical examination, and the history of the symptoms.[5] Generally if a person reports the typical radiating pain in one leg as well as one or more neurological indications of nerve root tension or neurological deficit, sciatica can be diagnosed.[11]


The most applied diagnostic test is the straight leg raise to produce Lasègue's sign, which is considered positive if pain in the distribution of the sciatic nerve is reproduced with between 30 and 70 degrees passive flexion of the straight leg.[12] While this test is positive in about 90% of people with sciatica, approximately 75% of people with a positive test do not have sciatica.[5]


Imaging tests such as computerised tomography or magnetic resonance imaging can help with the diagnosis of lumbar disc herniation.[13] The utility of MR neurography in the diagnoses of piriformis syndrome is controversial.[7]
Management


When the cause of sciatica is lumbar disc herniation, most cases resolve spontaneously over weeks to months.[14] Initially treatment in the first 6–8 weeks should be conservative.[5] There does not appear to be a significant difference in outcomes between advice to stay active and recommendations of bed rest.[15] Similarly, physical therapy (exercises) has not been found better than bed rest.[16]
Surgery


Surgery for unilateral sciatica involves the removal of part of the disc, known as a discectomy. While it results in short term benefits, long term benefits appear equivalent to conservative care.[5][20] Treatment of the underlying cause of the compression is needed in cases of epidural abscess, epidural tumors, and cauda equina syndrome.






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