Sciatica

Sciatica, also called sciatic pain or lumbosacral radiculopathy, is a syndrome characterized by localized pain in the area that follows the path of the sciatic nerve.

• More than 80% of people suffer an episode of lumbosciatica in their lifetime and in more than 85% the cause is nonspecific.
• The main symptom of sciatica is pain in the lower back, which worsens with movement and improves with rest.
• As you are insured by Mapfre, you have a 24-hour medical service that allows you to contact a team of specialists at any time.

Sciatic nerve

The sciatic nerve is formed from the L4, L5, S1, S2, and S3 nerve roots of the spinal cord. It is the widest and longest nerve in the human body. Formed by the confluence of these roots, it originates as such in the pelvis and goes towards the gluteal region, descending along the thigh, where it bifurcates into two branches, one towards the external part of the thigh (external popliteal sciatic nerve) and another towards the internal aspect (internal popliteal sciatic nerve).

Isolated sciatica occurs rarely without concomitant pain in the lower back. In low back pain -popularly known as lumbago- pain, stiffness or muscle tension occurs in the area located below the ribs and above the buttocks, and if the sciatic nerve is affected, this pain radiates -spread- thigh down, being able to reach the knee and even the foot.

Incidence

More than 80% of people suffer from lumbosciatica throughout their lives and in more than 85% of these cases the cause is nonspecific, that is, there is no underlying muscle, tendon, nerve or bone disorder that causes it. The rest of cases (less than 15%) are due to other entities, such as:

• Herniated disc
• Medullary canal stenosis
• Compression by the piriformis muscle
• Pregnancy
• Vertebral fracture or crush
• Ankylosing spondylitis
• Infections
• cancer

70% of sciatica cases evolve favorably and with a complete resolution of symptoms within 4-6 weeks of their onset. However, in 30% of cases, these can become chronic and more resistant to treatment, persisting even after a year of starting.

Symptoms

The main symptom of sciatica is pain in the lumbar area, a pain with mechanical characteristics, that is, it worsens with movement and improves when resting, generally sitting or lying down with the knees bent. Characteristically, the pain follows the path of the nerve and, depending on the degree of involvement, can reach the buttock, the thigh, the knee, or even the foot. The examination should assess the limb's ability to move and its sensitivity, as well as reflexes. pain occurs when trying to lift the leg straight and there may be a tingling or a pinching sensation in the inner thigh and leg, the back of the foot, or the outer edge of the foot, depending on the affected nerve roots, which are usually in general L5 and S1. In cases of severe compression, mobility can be compromised, making it impossible to extend the knee or flex the ankle up or down.

Diagnosis

Physical examination and history are usually sufficient to diagnose sciatica, and no need to request additional investigations unless severe disease is suspected due to other accompanying symptoms. The method of choice is usually the one that allows the morphology of the vertebral discs to be seen. However, it should not be ordered routinely in any sciatica, but only if a herniated disc or spinal canal stenosis is suspected when symptoms persist beyond 4-6 weeks with treatment. Sometimes an electromyogram (EMG) can also be performed to assess the possible involvement of nerve conduction.

Treatment

No treatment has shown an obvious significant benefit for the treatment of sciatica. Absolute rest is discouraged and only in the case of very disabling pain would it be indicated for no more than 48 hours, since recovery is slower afterwards. Dry local heat for a few minutes several times a day can help to alleviate the pain slightly.

In most cases the pain improves in less than 4-6 weeks and during this period it is usually treated with analgesia (paracetamol, metamizole) and if it does not improve, NSAIDs (ibuprofen, diclofenac, dexketoprofen) can be used. The use of other drugs such as injectable corticosteroids or opioids and muscle relaxants, despite their usual use in these cases, have not shown a positive effect on the evolution of sciatica, that is, they do not shorten the duration of symptoms in patients. studies carried out, although they evidently relieve pain in the short and medium term.

Surgery and other less conservative therapies, such as infiltrations, blockages, or radiofrequency denervations, should be reserved for patients with herniated discs with significant pain and disability despite drug treatment or in whom neurological involvement increases over time . In the case of medullary canal stenosis, decompressive surgery - once it has been seen that there is no response to the most conservative treatment - improves pain and quality of life in these patients.

The different rehabilitation or physical therapy techniques (exercise, behavioral therapy, posture education, back school) may be useful but there is insufficient scientific evidence, being low in the case of exercise, behavioral therapy and multidisciplinary therapy. Passive techniques such as ultrasound, electrotherapy, or traction are discouraged. Spinal manipulations (osteopathy) must always be performed by a qualified professional and not be used in the acute moment of sciatica.