{{infobox disease | name | Sciatica | Image Gray1244.png | Caption Left gluteal region, showing surface markings for arteries and sciatic nerve | DiseasesDB | ICD10 - | ICD9 | ICDO | OMIM | MedlinePlus | eMedicineSubj emerg | eMedicineTopic 303 | MeshID D012585 }} |
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Although sciatica is a relatively common form of low back pain and leg pain, 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, causing the pain. This point is important, because treatment for sciatica or sciatic symptoms will often be different, depending upon the underlying cause of the symptoms.
The first known use of the word sciatica dates to 1451.
Pseudosciatica or non-discogenic sciatica, which causes symptoms similar to spinal nerve root compression, is most often referred pain from damage to facet joints in the lower back and is felt as pain in the lower back and posterior upper legs. 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 (see piriformis syndrome and see below).
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.
Sciatica caused by pressure from a disc herniation and swelling of surrounding tissue can spontaneously subside if the tear in the disc heals and pulposis extrusion and inflammation cease.
Sciatica can be caused by tumours impinging on the spinal cord or the nerve roots. Severe back pain extending to the hips and feet, loss of bladder or bowel control, or muscle weakness, may result from spinal tumours. Trauma to the spine, such as from a car accident, may also lead to sciatica.
The most applied diagnostic test is the straight leg rising test, or Lasègue's sign, which is considered positive "if pain in the sciatic distribution is reproduced between 30 and 70 degrees passive flexion of the straight leg"
If no improvement in symptoms has occurred in six weeks or red flags are present, imaging is appropriate. Imaging may include either CT or MRI. MR neurography has been shown to diagnose 95% of severe sciatica patients, while as few as 15% of sciatica sufferers in the general population are diagnosed with disc-related problems. MR neurography may help diagnose piriformis syndrome which is another cause of sciatica that does not involve disc herniation.
Although medications are commonly prescribed for the treatment of sciatica, the UK's National Health Service reports that "There is no good evidence from clinical trials to guide the use of analgesics to relieve pain and disability", and suggests that recommendations for analgesic use are extrapolated from guidelines on low back pain. Research has shown no significant difference between placebo and either NSAIDs, analgesics, or muscle relaxants, while evidence for opioids and compound drugs is lacking.
Research has failed to show a significant difference in outcomes between advice to stay active and recommendations of bed rest. Similarly, physical therapy (exercises) has not been found to be better than bed rest.
Elective surgery is the main option for unilateral sciatica and focuses on removal of the underlying cause by removing disk herniation and eventually part of the disc. In a controlled study, surgical intervention was found to have better results after one year but after four and ten year follow ups no significant differences were found.
A comprehensive systematic review found moderate quality evidence that spinal manipulation is effective for the treatment of acute sciatica, however, only low level evidence was found to support spinal manipulation for the treatment of chronic sciatica.
Category:Peripheral nervous system disorders Category:General practice
ar:عرق النسا de:Ischialgie et:Ishias es:Ciática fa:درد سیاتیک fr:Sciatique hi:सायटिका it:Sciatalgia nl:Ischias ja:坐骨神経痛 no:Isjias pl:Rwa kulszowa pt:Ciática fi:Iskias sv:Ischias tr:Siyatik hastalığıThis text is licensed under the Creative Commons CC-BY-SA License. This text was originally published on Wikipedia and was developed by the Wikipedia community.
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