The sciatica is in pain along the sciatic nerve. It is usually caused by compression of nerve roots in the lower lumbar area. Common causes include intervertebral Diskusprolabs, osteophytes and narrowing of the spinal canal (spinal stenosis). The symptoms are radiating pain from the buttocks to the legs. The diagnosis sometimes also includes MRI or CT. By electromyography and nerve study of the amount in question can be determined. Treatment involves symptomatic treatment and sometimes surgery, v. a. If neurological deficits are present.
The sciatica is in pain along the sciatic nerve. It is usually caused by compression of nerve roots in the lower lumbar area. Common causes include intervertebral Diskusprolabs, osteophytes and narrowing of the spinal canal (spinal stenosis). The symptoms are radiating pain from the buttocks to the legs. The diagnosis sometimes also includes MRI or CT. By electromyography and nerve study of the amount in question can be determined. Treatment involves symptomatic treatment and sometimes surgery, v. a. If neurological deficits are present. Etiology The sciatica is typically a nerve root compression, mostly due to a disc prolapse (herniation of the nucleus pulposus), by bony irregularities (z. B. arthritic osteophytes, spondylolisthesis), spinal stenosis or, less frequently, caused by intraspinal tumors or abscesses. The compression may be in the intraspinal canal or the intervertebral foramen. The nerve can be compressed outside the spine, z. As in the pelvis or buttocks. Most common are the roots of L5 / S1, L4 / L5 and L3 / L4 affected (see Table: Effects of spinal cord dysfunction after segment height). Symptoms and complaints The pain radiates in the course of the sciatic nerve, usually on the buttocks and the back of the thigh to below the knee. The pain typically has a burning, lancinating or stinging character. It can occur with or without deep-seated back pain. The Valsalva maneuver or cough can worsen pain due to a herniated disc. Patients complain of numbness and sometimes weakness in the affected leg. The nerve root compression can sensory or motor failure or, as most objective finding a reflex deficit have resulted (spinal cord compression). A L5 / S1 prolapse may affect the Achilles tendon reflex, prolapse at L3 / L4 of the patellar tendon. Raising the outstretched leg can trigger a pain that radiates down into the leg when the leg is slowly above 60 ° and sometimes less lifted. This is sensitive to a sciatica. A more specific sign of a sciatica is pain radiating to the affected leg while the contralateral leg is lifted. The test with the lifting of the outstretched leg can be performed while seated in a bent by 90 ° hip joint; the lower leg is raised slowly until the knee is fully stretched. When a sciatica is present, the pain occurs in the spine (and often the radicular symptoms) when the leg is stretched. Diagnosis Clinical evaluation Sometimes MRI, electrodiagnostic studies, or both A sciatica is suspected in a characteristic pain. On suspicion motor skills, sensory and reflexes should be tested. When showing neurological symptoms or the symptoms persist longer than 6 weeks, imaging and electrodiagnostic tests should be done. Structural abnormalities (incl. A spinal stenosis) are best diagnosed by an MRI or CT. Electro-diagnostic tests can confirm the presence and extent of nerve root compression and exclude disorders that mimic a sciatica as polyneuropathy. These studies may help to clarify whether the lesions affect only one nerve or more and if the clinical findings consistent with the MRI findings (v. A. Important before any surgical intervention). However, abnormalities can be detected in electrodiagnostic studies only a few weeks after the onset of symptoms. Therapy bed rest (short), analgesics and sometimes medication to relieve the neuropathic pain surgery in severe cases, relief of acute pain may be due to bed rest for 24-48 h in a lying position is achieved, the head should be elevated about 30 °. Measures for the treatment of low back pain, including non-opioid analgesics (eg. As NSAIDs, acetaminophen) can be tried for up to 6 weeks. Drugs that relieve neuropathic pain (neuropathic pain: Treatment), such. As gabapentin or other anticonvulsants or low-dose tricyclic antidepressants (not a single substance from this group is superior to the other), the symptoms can improve. Initially, 100-300 mg gabapentin p.o. administered prior to bedtime, wherein the final dosage will typically be much higher, at up to 3600 mg / day. As with all sedatives particular caution should be paid in the elderly at risk of falling, in patients with arrhythmias and those with chronic kidney disease. Muscle spasms can (measures used to relieve pain and inflammation Rehabilitative) be solved by therapeutic heating or cooling applications, a physical therapy may be useful. Whether corticosteroids to treat acute radicular pain should be used, is controversial. Epidural given the corticosteroid can result in faster pain relief, but it should be used only for severe or persistent pain. The indication for a surgical procedure, there is no doubt in a disc prolapse and additionally one of the following criteria: muscle weakness progressive neurological deficits intolerable, persistent pain that massively affect the professional activity and the quality of life in an emotionally stable patients and not after 6 weeks of conservative treatment subside Some of these patients benefit from epidural corticosteroid instead of surgery. The classic discectomy with limited Laminotomy is the standard procedure for a intervertebral disk herniation. In localized herniation a microsurgical discectomy can be performed. This allows a smaller incision and Laminotomy. Chemonucleolysis with injection of chymopapain is no longer applied. Predictors of a small surgical success are: standing in the foreground psychiatric factors Symptompersistenz about> 6 months heavy physical work in the foreground standing nichtradikuläre back pain secondary gain (eg, litigation and compensation.) Summary The sciatica is typically a nerve root compression, mostly by a disc prolapse caused by arthritic osteophytes, spinal stenosis or spondylolisthesis. Classically, the burning, lancinating or stabbing pain in the course of the sciatic nerve radiates, usually over the buttocks and the rear side of the thigh, to below the knee. Sensory loss, weakness and loss of reflexes may occur. An MRI and electro diagnostic tests will be done if neurologic deficits or Symptompersistenz insist on> 6 weeks. Conservative treatment is usually sufficient, but a surgical procedure is to pull in a Diskusprolabs in conjunction with progressive neurological deficits or persistent, intractable pain into consideration.