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traumatology

Inflammation of the Sciatic Nerve

Generality

The inflammation of the sciatic nerve is the medical condition characterized by a peculiar pain along the lower limb, exactly where the sciatic nerve passes.

More commonly known as "sciatica" or "sciatica", the inflammation of the sciatic nerve is, in general, the result of the compression of the sciatic nerve itself or of the spinal nerves from which the sciatic nerve originates.

For the diagnosis of inflammation of the sciatic nerve the physical examination and anamnesis are almost always sufficient; for the recognition of the causes triggering the aforementioned condition, instead, instrumental tests are needed, such as magnetic resonance and electromyography.

Treatment of inflammation of the sciatic nerve varies according to the severity of the symptoms and the severity of the causal factor.

Brief anatomical reference to the sciatic nerve

Equal anatomical element, the sciatic nerve (or ischial nerve ) is the largest and longest nerve of the human body; in fact, it starts in the lower part of the back (at the level of the piriformis and gluteus muscles) and runs throughout the lower limb (it passes behind the thigh and the knee, and is distributed in front of and behind the leg), up to the foot (where it is divided between the back and the plant).

Derivation of the last two lumbar spinal nerves (L4 and L5) and of the first three sacral spinal nerves (S1, S2 and S3), the sciatic nerve is a very important nerve structure for the sensitivity and motility of the lower limb, in particular leg .

What is Sciatic Nerve Inflammation?

The inflammation of the sciatic nerve is the medical condition more properly known as sciatica or sciatica, which is mainly characterized by pain where the sciatic nerve passes.

Epidemiology

Inflammation of the sciatic nerve is a condition that most affects people aged 40-50 or older; therefore, it mainly affects middle-aged and elderly individuals.

Regarding the most affected sex, inflammation of the sciatic nerve is decidedly more common in men than in women.

Causes

The most common cause of inflammation of the sciatic nerve is compression, with irritative effects, of the sciatic nerve itself or of one or more of the spinal nerves that originate it.

The compression with irritative effects of the sciatic nerve or of one of the spinal nerves placed at its origin may depend on various conditions, including:

  • Lumbar -sacral disc herniation (ie between the lumbar and sacral tracts of the spine). Represents the main cause of inflammation of the sciatic nerve; according to statistics, in fact, it would play a leading role in at least 15% of episodes of inflamed sciatic nerve.
  • Lumbosacral degenerative discopathy . Discopathy is the medical term for any disease of the intervertebral disc.
  • Low back vertebral stenosis . Also known as spinal stenosis, vertebral stenosis is the pathological narrowing of a portion of the vertebral canal (or spinal canal), ie the canal in which the spinal cord takes place.
  • Low-lobed foraminal stenosis . In medicine, the term foraminal stenosis indicates the pathological narrowing of the small channels through which the roots of the spinal nerves run, which depart from the spinal cord.
  • Lumbo-sacral spondylolisthesis . Spondylolisthesis is a disease of the spine, in which one vertebrae occurs on the other.
  • Piriformis syndrome . It is the set of symptoms that arise from the compression of the sciatic nerve, exerted by the piriformis muscle.

    As a rule, the piriformis is the protagonist of a compression with irritative and inflammatory effects, after having suffered a trauma or a contracture.

  • Spinal tumor along the lumbo-sacral tract of the spine . Since they are cell masses of a certain volume and in continuous expansion, spinal tumors - ie tumors located along the vertebral column - can push on the spinal cord, on the spinal nerves and / or on the spinal nerve roots, and cause its compression.
  • State of pregnancy at an advanced stage . In this circumstance, the compression phenomenon that causes inflammation of the sciatic nerve is due to the very large uterus, due to the now fully developed fetus.

Other causes of inflammation of the sciatic nerve

The inflammation of the sciatic nerve can also be the result of a traumatic lesion of the sciatic nerve.

Among the main causes of traumatic lesion of the sciatic nerve, there are: the displaced fractures of the thigh or leg bones and the excision of the sciatic nerve, practiced in a completely involuntary manner by the surgeons during hip replacement procedures.

Risk factors of sciatic nerve inflammation

To promote inflammation of the sciatic nerve are factors such as:

  • Advanced age . With the aging of the human body, the vertebral column is subject to changes in form, changes that predispose to the disc herniation.
  • Obesity . In the long run it can modify the spine and expose it to the development of discal hernias.
  • The habit of assuming incorrect postures . Sitting inappropriately favors the development of herniated discs.
  • Work activities where it is common to lift weights or twist your back . It should be pointed out that the correlation between the inflammation of the sciatic nerve and the aforementioned work activities is only reflected in the statistics; in fact, the scientific studies conducted on this subject have not yet demonstrated the aforementioned connection.
  • Diabetes . In the long run, this widespread metabolic disease can cause deterioration of peripheral nerves (diabetic neuropathy), including the sciatic nerve.
  • A sedentary lifestyle . The comparison between extremely sedentary people and very active people has shown that the former are much more prone to sciatica than the latter.
  • The traumas directed to the buttocks, thighs or legs . These unpleasant events are associated with a non-negligible risk of sciatic nerve injury.
  • Arthritis of the spine . With the inflammation of the joints of the spine, the latter is the victim of changes, changes that make the compression of the spinal nerves (including the sciatic nerve) more probable.
  • Pathologies of the vertebral column (eg, vertebral stenosis, foraminal stenosis, spondylolisthesis, etc.) located along the lumbo-sacral tract.
  • Hip prosthesis operations . The involuntary excision of the sciatic nerve during hip replacement operations is, fortunately, a very rare circumstance.

Symptoms and Complications

More often unilateral than bilateral, the inflammation of the sciatic nerve is responsible, always and from the beginning, for an annoying pain in the anatomical areas in which the sciatic nerve passes.

The characteristics of the pain that derives from the inflammation of the sciatic nerve vary in relation to the triggering causes: some causal factors produce a burning pain, acute, penetrating and persistent; other causal factors, on the other hand, determine a slight painful sensation, which, however, in a completely sudden way, becomes acute, resulting similar to an electric shock.

Moreover, according to the testimonies of numerous patients, the pain produced by the inflammation of the sciatic nerve tends to increase temporarily after intense physical exertion, coughing or sneezing and coinciding with moments of stress, anxiety or tension.

Curiosity

Having a specific site and presenting peculiar characteristics, the painful sensation that arises from the inflammation of the sciatic nerve is also known as sciatic pain .

Other typical symptoms of sciatic nerve inflammation

Shortly after the onset, in the same lower limb in which it produces pain, the inflammation of the sciatic nerve induces other symptoms, which are: tingling, muscle weakness, sense of numbness, more or less profound alteration of skin sensitivity and difficulty in motor control .

As a rule, the pain and other symptoms that arise from the inflammation of the sciatic nerve locate very rarely in the same spot; this means that most patients tend to feel pain in one area (eg buttock), tingling in another area (eg thigh), muscle weakness in another area again (eg: leg) and so on.

Complications

If the compression / injury to sciatic nerve damage is severe or if the treatments are inadequate, the inflammation of the sciatic nerve can lead to various complications, such as:

  • Lameness;
  • Loss of control of the anal sphincter and visceral sphincter;
  • Total absence of sensitivity along the affected lower limb;
  • Strong sense of muscle weakness along the lower limb involved.

When should I go to the doctor?

The inflammation of the sciatic nerve deserves a series of medical investigations, when:

  • Despite the rest, there is a worsening of symptoms, rather than an improvement;
  • The symptoms suddenly worsened and without any reason;
  • The symptoms appeared after a violent trauma to the back;
  • In addition to the classic symptoms (pain, tingling, etc.), the patient also has poor control of intestinal functions (indicating involvement of the anal sphincter) and / or bladder functions (it is indicative of an involvement of the bladder sphincter).

Diagnosis

In most circumstances, an accurate physical examination and a scrupulous medical history are sufficient to reach the diagnosis of inflammation of the sciatic nerve.

Once the presence of an inflammation of the sciatic nerve has been identified, the diagnostic researches are by no means finished, but must continue with the aim of discovering the triggering causes .

The search for factors that cause inflammation of the sciatic nerve is very important, because it is on causal factors that doctors base the most appropriate treatment planning (readers are reminded that sciatica can depend on very different causes and that for each of these there is a specific treatment).

The tests that help doctors to identify the causes of an inflammation of the sciatic nerve include:

  • X-rays to the spine . They allow to assess the state of health of the spine and to identify, when particularly evident, disk hernias, vertebral stenoses, foraminal stenoses, etc.
  • Lumbosacral magnetic resonance . It is a safe and completely harmless radiological exam, which allows us to identify, even when they are not very evident, any spinal tumors, disc hernias, vertebral stenoses, foraminal stenoses, etc.
  • CT on the spine . It has a diagnostic power, as far as vertebral column diseases are concerned, equal if not greater than that of MRI.

    Unfortunately, however, it exposes the patient to a non-negligible dose of ionizing radiation.

  • Electromyography . It allows to evaluate the conduction of nerve impulses along the sciatic nerve and to study its functioning.

Therapy

Treatment of inflammation of the sciatic nerve varies according to two factors: the severity of the symptomatology and the severity of the triggering factor.

In practical terms, this means that:

  • If the inflammation of the sciatic nerve is mild and depends on clinically insignificant causes, the planned therapy is based on rest until the complete disappearance of the symptoms and on the modification of some incorrect postural habits ;
  • If, on the other hand, the inflammation of the sciatic nerve is severe (or does not improve with rest at all) and at its origin there are clinically relevant causes, the treatment adopted may include: drug therapy, physiotherapy and, in extreme cases, even therapy surgical .

drugs

Among the drugs that doctors adopt in the event of inflammation of the sciatic nerve, include:

  • Anti- inflammatories of the NSAID type (Non-Steroidal Anti-Inflammatory Drugs), such as ibuprofen;
  • Muscle relaxants, such as Muscoril;
  • Tricyclic antidepressants or, alternatively, anticonvulsants . Usually indicated for other purposes (respectively, depression and epilepsy), these medicines have shown a certain efficacy also on the pain produced by the compression of peripheral nerves (neuropathic pain);
  • Corticosteroids given intravenously. They are medicines with a very powerful anti-inflammatory power, which, however, doctors prefer to use only in extreme cases, because of their possible serious side effects (glaucoma, hypertension, diabetes, cataracts, osteoporosis, etc.).

Physiotherapy

Physiotherapy for those suffering from an inflammation of the sciatic nerve consists of a rehabilitation program of exercises, which allows you to: correct and improve your posture, strengthen your back muscles and, finally, increase the flexibility of your trunk and spine.

Surgery

The cases of inflammation of the sciatic nerve candidates for surgery are those in which:

  • Suffering from the sciatic nerve depends on a disease of the spine (eg: lumbo-sacral disc herniation, lumbosacral spinal stenosis, spondylolisthesis, etc.), whose symptoms are severe and have been shown to be insensitive to the previously listed treatments;
  • The sciatic nerve suffering is due to a spinal tumor along the lumbar-sacral tract of the spine.

As can be seen, surgery is an option reserved for patients in whom the inflammation of the sciatic nerve is linked to a problem in the spine; this excludes, therefore, the use of surgery in a case of sciatica due to a condition such as the piriformis syndrome (even when the latter is severe).

WHAT IS THE SURGICAL INTERVENTION?

The surgical operations for the resolution of those diseases or those tumors of the spine that cause inflammation of the sciatic nerve are very delicate operations; the surgeon who performs them, in fact, must act on the segment of the spinal column concerned, eliminating the imperfection or the tumor present, in such a way as to annul the nerve compression (NB: in these situations, the compression concerns the roots of the constituent spinal nerves the sciatic nerve).

Obviously, the post-operative phase includes an absolute rest period and a series of physiotherapy treatments; for a complete recovery from surgical operations like those in question, it takes a few months.

Tips and home remedies

Among the main home remedies recommended by experts in the field of sciatic nerve inflammation, include:

  • Rest from heavier physical activities and sports. This rest should not result in complete physical inactivity, because otherwise there could be a worsening of the symptoms;
  • Application of cold packs, alternated with hot packs, at the level of the painful area (s);
  • Daily stretching of the back muscles. A constant muscle lengthening of the back can considerably attenuate the compression of the sciatic nerve along the column.

Prognosis

In the presence of an inflammation of the sciatic nerve, the prognosis depends mainly on the triggering factors: if the cause is treatable, the resulting inflammation of the sciatic nerve heals with excellent results and in a short time; if instead the cause is difficult to treat or imposes a very articulated therapeutic plan, the consequent sciatica presents very long healing times (we talk about months).

Prevention

At the moment, there is no remedy or a series of remedies that prevent inflammation of the sciatic nerve with a probability close to or equal to 100%. However, there are various precautionary measures that greatly reduce the risk; these precautionary measures are:

  • Use your body properly, while lifting weights, and avoid excessive back torsions. There are numerous online guides that teach how to lift a weight without burdening the spine.
  • Maintain a correct posture, especially in a sitting position, so as not to alter the normal anatomy of the spine.
  • Exercise regularly, because inactivity is an important and established factor predisposing to inflammation of the sciatic nerve.

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