Sciatica
The content of the article:
- Causes
- Signs of lumboischialgia
- Diagnostics
- Lumboischialgia treatment
- Prevention
- Possible consequences
Lumboischialgia is a clinical syndrome associated with irritation of the spinal nerve roots that form the sciatic nerve, and manifests itself in pain of varying degrees of severity in the lower back, buttock and hamstring.
Source: spina-sustav.ru
Lumboischialgia usually occurs in young and middle-aged people (22–45 years old).
Causes
Lumboischialgia most often occurs as one of the symptoms of spinal diseases (osteochondrosis, spondyloarthrosis, intervertebral hernia of the lumbar spine, spondylolisthesis, etc.). Less commonly, the cause of lumboischialgia is myofascial syndrome (muscle or extra-articular rheumatism, overuse syndrome, muscle tension pain), which affects the muscles of the lower back.
Irritation of bone, ligamentous and muscle structures can provoke the appearance of lumboischialgia. For example, in elderly patients, coxarthrosis (deforming osteoarthritis of the hip joint) often becomes the cause of pain in the lower back with irradiation to the lower extremity.
Factors provoking lumboischialgia are:
- prolonged stay in an uncomfortable position;
- hypothermia;
- sharp turns of the body;
- overheating, followed by too rapid cooling of the body.
The risk group for lumboischialgia includes people with chronic diseases of the spine, overweight, doing hard physical work or for a long time during the day in a forced situation (transport drivers, workers on a conveyor belt, etc.).
The pathological mechanism of lumboischialgia depends on the underlying cause. These reasons include:
- Piriformis syndrome. The piriformis muscle is located under the gluteus muscle. Compression of the L5 or S1 nerve roots, which occurs against the background of osteochondrosis or intervertebral hernias, as well as unsuccessful injections into the gluteal region, contribute to a significant increase in the tone of the piriformis muscle. This, in turn, leads to compression of the sciatic nerve and the blood vessels passing in the sub-pyriform space.
- Intervertebral hernia. Degenerative processes in the intervertebral disc tissue lead to compression of the sciatic nerve roots and the occurrence of aseptic inflammation. At the same time, motor and sensory nerve fibers are irritated, which is accompanied by the appearance of reflected pain.
- Facet syndrome. It is caused by limitation of mobility or, conversely, by pathological mobility of the spine associated with deforming osteoarthritis of the facet joints. As a result, the patient experiences reflected pain, that is, signs of lumboischialgia appear.
Signs of lumboischialgia
The main symptom of lumboischialgia is a sudden attack of pain in the lower back, buttock, and back of the thigh. The pain is shooting, burning, or aching. It causes a reflex muscle spasm, which, in turn, further increases the compression and irritation of the nerve roots that form the sciatic nerve.
The main signs of lumboischialgia are:
- pain localized in the lower back and back of the thigh;
- limitation of mobility of the spine in the lumbosacral region (plaque symptom);
- acceptance by the patient of a forced position (slightly bent forward);
- lameness when walking with support on the good leg;
- deviation of the body towards the healthy leg;
- a decrease in the severity of lumbar lordosis, but in some patients, on the contrary, hyperlordosis occurs;
- a tripod symptom (in a sitting position, patients rest their hands on the edge of a chair or bed, transferring body weight to them);
- Minor's symptom - when changing the position of the body, the patient first turns to the healthy side, and then pulls the injured leg with his hands.
Diagnostics
Diagnosis of lumboischialgia begins with a clinical examination of the patient, during which signs of tension on the sciatic nerve, possible symptoms of an inflammatory or oncological process are revealed. On palpation of the point of exit of the sciatic nerve to the thigh, there is a sharp increase in pain.
In order to identify the underlying pathology that led to the appearance of lumboischialgia (pathology of the spine, hip joints, abdominal and pelvic organs), an instrumental examination is performed:
- X-ray of the lumbar spine (osteophytes, uneven narrowing of the spinal canal, hypertrophy of the articular processes, sclerosis of the endplates, a decrease in the height of the intervertebral discs);
- radioisotope scintiography of the spine;
- computed or magnetic resonance imaging;
- myelography - the method is indicated for patients with symptoms of compression myelopathy (compression of spinal cord structures);
- ultrasound examination of the abdominal organs and kidneys;
- excretory urogrophy;
- lumbar puncture with subsequent laboratory analysis of the obtained cerebrospinal fluid - indicated for suspected infectious and inflammatory process.
If necessary, patients with lumboischialgia are referred for consultation to other narrow specialists (gastroenterologist, urologist, gynecologist, orthopedist, vertebrologist).
Lumboischialgia treatment
Treatment of lumboischialgia is aimed not only at relieving pain, but also at eliminating its root cause, that is, it includes therapy for osteochondrosis, spondylolisthesis, intervertebral hernias and other pathologies.
At the height of the severity of the pain attack, patients need bed rest. They are placed on a bed with an elastic, hard mattress in a prone position with legs bent and pulled up to the stomach, under which several pillows are placed. If the patient has lumbar hyperlordosis, the most optimal position for him will be lying on his stomach with a pillow placed under him.
In order to relieve pain, non-steroidal anti-inflammatory drugs are used. With a significantly pronounced pain syndrome, the implementation of blockades is shown - the injection of anesthetic and anti-inflammatory drugs directly into the focus of pain.
In the complex treatment of lumboischialgia, distracting local procedures (rubbing, pepper plaster) are widely used.
If the ongoing therapy does not lead to an improvement in the patient's condition, the issue of the advisability of stretching the spine in order to eliminate the compression of the nerve roots is considered.
After the signs of lumboischialgia subside, patients are shown physiotherapy (manual therapy, massage, therapeutic sleep, acupuncture, mud, ozocerite or paraffin applications). At the same time, special importance is given to therapeutic massage of the lumbosacral region, which improves blood supply and metabolic processes in tissues, helps to slow down the progression of degenerative processes in the intervertebral discs.
Medical treatment of lumboischialgia consists in the use of drugs of the following groups:
- muscle relaxants of central action;
- anti-inflammatory drugs;
- agents that improve microcirculation;
- antispasmodics;
- multivitamins.
Indications for surgical treatment of lumboischialgia:
- ineffectiveness of long-term conservative therapy;
- paraparesis of the lower extremities;
- dysfunction of the pelvic organs.
The following types of surgical interventions are most often performed:
- microdiscectomy;
- discectomy;
- endoscopic discectomy;
- plastic of the intervertebral disc.
In order to prevent recurrence of lumboischialgia, regular exercise therapy is recommended. Dosed exercises help to strengthen the muscles of the back and abdominal muscles, the ligamentous apparatus of the spine, as well as to increase their resistance to stress. Start to engage in physiotherapy exercises should be under the guidance of an instructor. You cannot use exercise complexes taken from popular sources (magazines, newspapers, Internet sites), since any incorrectly performed movement can lead to infringement of the nerve roots and the development of a new attack of lumbar ischialgia. Only after patients have fully mastered the correct exercise technique can they do it on their own at home.
If patients with lumboischialgia are overweight, a low-calorie diet is indicated. Normalization of body weight is an important link in the treatment of lumboischialgia and also helps to reduce the risk of recurrence of pain attacks.
During the period of remission, spa treatment is indicated 1-2 times a year (radon baths, mud therapy, climatic factors).
Prevention
Lumboischialgia prevention is based on the following areas:
- timely detection and active treatment of diseases of the musculoskeletal system;
- maintaining an active lifestyle;
- control of body weight;
- to give up smoking;
- the formation of correct posture;
- prevention of hypothermia, as well as overheating, followed by rapid cooling of the body;
- avoidance of sharp bends of the body from side to side, back and forth.
Possible consequences
In 95% of cases, lumboischialgia is caused by degenerative processes in the spine (osteochondrosis) and is benign. With timely treatment started and the elimination of provoking factors, pain attacks rarely occur.
If the root cause of lumboischialgia is not eliminated, pain attacks will recur more and more often, as a result of which the quality of life of patients will significantly deteriorate.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
