1. Sciatica
From Wikipedia, the free encyclopedia
Sciatica
Classification and external resources
Left gluteal region, showing surface markings for arteries and
sciatic nerve
ICD-10
M54.3-M54.4
ICD-9
724.3
MedlinePlus
000686
eMedicine
emerg/303
MeSH
D012585
Sciatica (/saɪ ˈ
ætɪ kə/; sciatic neuritis, sciatic neuralgia,[1] or lumbar radiculopathy[2][3]) is a set of
symptoms including pain caused by general compression or irritation of one of five spinal nerve roots of
each sciatic nerve—or by compression or irritation of the left or right or both sciatic nerves. Symptoms
include lower back pain, buttock pain, and pain, numbness or weakness in various parts of the leg and foot.
Other symptoms include a "pins and needles" sensation, or tingling and difficulty moving or controlling the
leg. Typically, symptoms only manifest on one side of the body. The pain may radiate below the knee, but
does not always.
Sciatica is a relatively common form of low back and leg pain, but the true meaning of the term is often
misunderstood. Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the
nerve to cause the pain. Treatment for sciatica or sciatic symptoms often differs, depending on underlying

2. causes and pain levels. Causes include compression of the sciatic nerve roots by a herniated (torn) or
protruding disc in the lower back.
The first known use of the word sciatica dates from 1451.[4]
Contents
1 Definition
2 Cause
o 2.1 Spinal disc herniation
o 2.2 Spinal stenosis
o 2.3 Piriformis syndrome
o 2.4 Pregnancy
o 2.5 Other
3 Pathophysiology
4 Diagnosis
5 Management
o 5.1 Medication
o 5.2 Surgery
o 5.3 Epidurals
o 5.4 Alternative medicine
6 Epidemiology
7 References
Definition
The term sciatica describes a symptom rather than a specific disease. Some use it to mean any pain starting
in the lower back and going down the leg. Others use the term more specifically to mean a nerve
dysfunction caused by compression of one or more lumbar or sacral nerve roots from a spinal disc
herniation. Pain typically occurs in the distribution of a dermatome and goes below the knee to the foot. It
may be associated with neurological dysfunction, such as weakness.[5] The pain is characteristically of
shooting type, quickly traveling along the course of the nerve. [6]
Cause
Spinal disc herniation
Main article: 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
Main article: Lumbar 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

3. 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.
Pathophysiology
Sciatica is generally caused by the compression of lumbar nerves L3, L4, or L5 or sacral nerves S1, S2, or
S3, or by compression of the sciatic nerve itself. When sciatica is caused by compression of a dorsal nerve
root (radix), it is considered a lumbar radiculopathy (or radiculitis when accompanied with an inflammatory
response). This can occur as a result of a spinal disk bulge or spinal disc herniation (a herniated
intervertebral disc), or from roughening, enlarging, or misalignment (spondylolisthesis) of the vertebrae, or
as a result of degenerated discs that can reduce the diameter of the lateral foramen (natural hole) through
which nerve roots exit the spine. The intervertebral discs consist of an annulus fibrosus, which forms a ring
surrounding the inner nucleus pulposus. When there is a tear in the annulus fibrosus, the nucleus pulposus
(pulp) may extrude through the tear and press against spinal nerves within the spinal cord, cauda equina, or
exiting nerve roots, causing inflammation, numbness, or excruciating pain. Inflammation in the spinal canal
can also spread to adjacent facet joints and cause lower back pain and/or referred pain in the posterior
thigh(s). Pseudosciatic pain can also be caused by compression of peripheral sections of the nerve, usually
from soft tissue tension in the piriformis or related muscles.
The spinal discs are composed of a tough spongiform ring of cartilage ("annulus fibrosus") with a more
malleable center ("nucleus pulposus"). The discs separate the vertebrae, thereby allowing room for the
nerve roots to properly exit through the spaces between the vertebrae. The discs cushion the spine from
compressive forces, but are weak to pressure applied during rotational movements. That is why a person
who bends to one side, at a bad angle to pick something up, may more likely herniate a spinal disc than a
person jumping from a ladder and landing on their feet.
Herniation of a disc occurs when the liquid center of the disc bulges outwards, tearing the external ring of
fibers, extrudes into the spinal canal, and compresses a nerve root against the lamina or pedicle of a
vertebra, thus causing sciatica. This extruded liquid from the "nucleus pulposus" may cause inflammation
and swelling of surrounding tissue, which may cause further compression of the nerve root in the confined
space in the spinal canal.
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]

4. 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]
Medication
Although medicines are commonly prescribed for the treatment of sciatica, evidence for analgesics is
poor.[17] Specifically, NSAIDs do not appear to improve immediate pain and all NSAIDs appear about
equivalent.[17] Evidence is also lacking in use of opioids and muscle relaxants. In those with sciatica due to
piriformis syndrome, botulism toxin injections may improve pain and or function. [18]
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][19] Treatment of
the underlying cause of the compression is needed in cases of epidural abscess, epidural tumors, and cauda
equina syndrome.
Epidurals
Good quality of evidence to suggest short-term pain reduction with epidural steroid injections, long-term
benefit is controversial. Other agents, ex: TNF inhibitors, have not shown efficacy in most randomized
controlled trials.[citation needed]
Alternative medicine
Moderate quality evidence suggests that spinal manipulation is an effective treatment for acute sciatica.[20]
For chronic sciatica the evidence is poor.[20] Spinal manipulation has been found generally safe for the
treatment of disc-related pain; however, case reports have found an association with cauda equina
syndrome[21] and it is contraindicated when there are progressive neurological deficits.[22]
Epidemiology
Depending on how it is defined, 1.6% to 43% of people have sciatica. [5]
References
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3.
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Jump up ^ New Jersey Pain Care Center, "Lumbar Radiculopathy (Sciatica)", 2010
Jump up ^ "sciatica" at Dorland's Medical Dictionary
Jump up ^ Oxford English Dictionary, 2nd Ed. "a1450a Mankind (Brandl)."
^ Jump up to: abcdefgh Valat, JP; Genevay, S; Marty, M; Rozenberg, S; Koes, B (2010 Apr).
"Sciatica.". Best practice & research. Clinical rheumatology24 (2): 241–52.
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Jump up ^ Kirschner, Jonathan S.; Foye, Patrick M.; Cole, Jeffrey L. (2009). "Piriformis
syndrome, diagnosis and treatment". Muscle & Nerve40 (1): 10–18. doi:10.1002/mus.21318.
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Jump up ^ Lewis, A. M.; Layzer, R.; Engstrom, J. W.; Barbaro, N. M.; Chin, C. T. (2006).
"Magnetic Resonance Neurography in Extraspinal Sciatica". Archives of Neurology63 (10): 1469–
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Jump up ^Sciatic nerve compression during pregnancy
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navigating evaluation and treatment choices". American family physician78 (7): 835–42.
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low-back pain and sciatica.". Cochrane database of systematic reviews (Online) (4): CD001254.
doi:10.1002/14651858.CD001254.pub2. PMID 15495012.
Jump up ^ Luijsterburg, Pim A. J.; Verhagen, Arianne P.; Ostelo, Raymond W. J. G.; Os, Ton A.
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lumbosacral radicular syndrome: a systematic review". European Spine Journal16 (7): 881–899.
doi:10.1007/s00586-007-0367-1. PMC 2219647. PMID 17415595.
^ Jump up to: ab Pinto, RZ; Maher, CG; Ferreira, ML; Ferreira, PH; Hancock, M; Oliveira, VC;
McLachlan, AJ; Koes, B (2012 Feb 13). "Drugs for relief of pain in patients with sciatica:
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Jump up ^ Waseem, Z; Boulias, C; Gordon, A; Ismail, F; Sheean, G; Furlan, AD (2011 Jan 19).
"Botulinum toxin injections for low-back pain and sciatica.". Cochrane database of systematic
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