Sciatic Nerve Sciatico of A.Griguolo

Generality

The inflamed sciatic nerve is the jargon with which to indicate the medical condition known as sciatica, sciatica or inflammation of the sciatic nerve.

The inflamed sciatic nerve recognizes as the main cause the compression, with irritative effects, of the sciatic nerve; several factors can cause this compression, including: a herniated disc, a spinal stenosis, the piriformis syndrome, a foraminal stenosis, a discopathy etc.

As a rule, doctors come to the diagnosis of the inflamed sciatic nerve through the patient's account of symptoms, physical examination and medical history; to understand the causes of the nervous suffering in question, however, they need instrumental tests.

In a context of inflamed sciatic nerve, the therapy varies depending on the severity of the symptomatology 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 the Sciatic Nervous Nerve?

The inflamed sciatic nerve is the expression of jargon indicating the inflammation of the sciatic nerve or, as experts in the field say, sciatica or sciatica .

Epidemiology

The inflamed sciatic nerve is a problem that mainly affects people over the age of 40-50 (therefore middle-aged and elderly individuals).

According to the most reliable estimates, the male subjects are the ones who suffer most from the presence of the inflamed sciatic nerve.

Causes

In most cases, the condition known as the inflamed sciatic nerve is the result of compression, with irritative effects, of the sciatic nerve itself or of one of the spinal nerves that give rise to the sciatic nerve.

The compression with irritative effects of the sciatic nerve or one of its spinal nerves may depend on several circumstances, including:

Herniated disc between the lumbar spine and the sacral spine ( lumbo-sacral tract ). It represents the main cause of the inflamed sciatic nerve; according to statistics, in fact, it would be responsible for at least 15% of cases of inflammation of the sciatic nerve.

Lumbosacral degenerative discopathy . Discopathies are diseases 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), or the channel that contains the spinal cord.
Low-lobed foraminal stenosis . In the medical field, foraminal stenosis is the pathological narrowing of the small channels through which the roots of the spinal nerves exit from the spinal cord.
Lumbo-sacral spondylolisthesis . Spondylolisthesis is a disease of the spine, characterized by the sliding of one vertebra on the other.
Piriformis syndrome . It is the set of symptoms that follow the compression of the sciatic nerve exerted by the piriformis muscle.
As a rule, the piriformis muscle compresses the sciatic nerve with irritative and inflammatory effects, after having suffered a trauma or a contracture.
Lumbosacral spinal tumor . Since they are cell masses of a certain volume and in continuous expansion, spinal tumors - ie tumors located along the spinal column - can push on the spinal cord, on the spinal nerves and / or on the roots of the spinal nerves and cause their compression.
State of pregnancy at an advanced stage . In this situation, the responsible compression of the inflamed sciatic nerve depends on the very large uterus, due to the now fully developed fetus.

Other causes of inflamed sciatic nerve

The presence of the inflamed sciatic nerve can also derive from a traumatic lesion of the sciatic nerve.

Among the most important causes of traumatic injury of the sciatic nerve are: the displaced fractures of the thigh or leg bones and the excision of the sciatic nerve, performed involuntarily by surgeons during hip replacement procedures.

Who is most at risk?

The people most at risk of suffering from the inflamed sciatic nerve are:

The elderly . As we age, the spine develops changes in shape, which predispose to the herniated disc.
The obese. In the long run, obesity can modify the spine and export it to the development of herniated discs.

Those who, by habit, assume incorrect postures . For example, sitting inappropriately favors the appearance of disc herniations.
Who, for work, lifts weights or twists his back frequently. Although the statistics show the existence of a correlation between sciatica and lifting weights or twisting the back, no scientific study has so far demonstrated this association.
Diabetics. Diabetes can cause deterioration of peripheral nerves (diabetic neuropathy), including the sciatic nerve.
People prone to a sedentary lifestyle . The comparison between extremely sedentary subjects and very active subjects has shown that the former are much more prone than the latter to suffer from sciatica.
Sufferers from arthritis of the spine . The inflammation of the joints of the spine alters the anatomy of the latter, favoring the compression of nerves such as the sciatic nerve.
Those who suffer from a spinal column pathology (eg spinal stenosis, foraminal stenosis, etc.) along the lumbar-sacral tract.
Victims of buttocks, thighs or legs. At the time of such traumas, injury to the sciatic nerve is possible.
Who undergoes hip replacement surgery. The involuntary excision of the sciatic nerve is, fortunately, one of the less common complications of hip replacement operations.

Symptoms and Complications

The inflamed sciatic nerve causes, always and from the beginning, an annoying pain in the anatomical sites where the sciatic nerve passes; this pain has different characteristics depending on the triggering causes: some causal factors of the inflamed sciatic nerve produce a burning pain, acute, penetrating and persistent; other causal factors of the inflamed sciatic nerve, on the other hand, cause a slight painful sensation, but subject, from time to time, to sudden sharpening similar to an electric shock.

Having a specific site and presenting specific connotations, the pain associated with the inflamed sciatic nerve is also known as sciatic pain .

When does the pain get worse?

The pain typical of the inflamed sciatic nerve tends to increase temporarily after intense physical exertion, coughing or sneezing; it also tends to become more intense even after moments of stress, anxiety or tension.

Other symptoms of the inflamed sciatic nerve

Shortly after the onset, in the same lower limb in which it causes pain, the inflamed sciatic nerve produces other symptoms, such as: tingling, muscle weakness, sense of numbness, alteration of skin sensitivity and difficulty in motor control .

Generally, the aforementioned symptoms rarely localize in the same place and where there is pain; this means that most patients experience a painful sensation in one area (eg back-thigh), tingling in another area (eg: gluteal muscle), numbness in another area (eg: leg) and so on.

Monolateral or bilateral?

The inflamed sciatic nerve is usually unilateral suffering, although it can affect both parts of the body ( bilateral inflamed sciatic nerve ).

Complications

If the health of the sciatic nerve is severely compromised or if the treatments are inappropriate, the inflamed sciatic nerve can lead to 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 inflamed sciatic nerve deserves a series of thorough medical analyzes, when:

Despite the rest, the symptoms worsen rather than improve;
There was a sudden and unreasonable worsening of the symptoms;
The symptoms follow a violent back injury;
In addition to the classic symptoms (eg pain), the patient complains of a loss of control of the anal sphincter or visceral sphincter.

Diagnosis

As a rule, to formulate the diagnosis of an inflamed sciatic nerve, information from the patient's symptoms, physical examination and medical history are sufficient.

What is the next step? The search for causes

Once the presence of a condition such as the inflamed sciatic nerve has been detected, it is the duty of the attending physician to initiate investigations for the discovery of the triggering causes.

The search for the factors that cause sciatica is essential for healing, as it is from these factors that the whole treatment plan depends.

Among the tests used to identify the causes of the inflamed sciatic nerve are:

X-rays to the spine . They allow to assess the state of health of the spine and to identify, if they are particularly evident, disk hernias, vertebral stenoses, foraminal stenoses, etc.
Lumbosacral magnetic resonance . It is a safe and completely harmless radiological exam, which allows to detect, 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 equal to or greater than that of magnetic resonance.
Unfortunately, however, it exposes the patient to a non-negligible dose of ionizing radiation.
Electromyography . It allows to study the conduction of nerve impulses along the sciatic nerve.

Therapy

The treatment of the inflamed sciatic nerve varies according to two factors: the severity of the symptomatology and the severity of the triggering cause.

In practical terms, this means that:

If the inflamed sciatic nerve is a minor condition and recognizes clinically insignificant causes, the treatment envisaged 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 inflamed sciatic nerve is a severe condition (or one that does not improve with rest) and derives from clinically relevant causes, the treatment adopted may consist of: drug therapy, physiotherapy and / or, in extreme cases, surgical therapy .

Did you know that ...

A therapy that depends on the causal factor is also called causal therapy.

drugs

The list of useful drugs for those suffering from inflamed sciatic nerve includes:

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 deriving from the compression of the peripheral nerves (neuropathic pain);
Corticosteroids with intravenous administration. 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

In a context of inflamed sciatic nerve, physiotherapy provides a rehabilitation program of exercises, aimed at: correcting and improving posture, strengthening the muscles of the back and, finally, increasing the flexibility of the trunk and spine.

Surgery

The cases of inflamed sciatic nerve candidates for surgical treatment are those in which:

The inflammation of the sciatic nerve depends on a disease of the spinal column (eg: lumbo-sacral disc herniation, lumbar-sacral spinal stenosis, spondylolisthesis, etc.), whose symptoms are severe and do not respond to previous treatments;
The inflammation of the sciatic nerve is related to a spinal tumor along the lumbo-sacral tract of the spine.

Considering the aforementioned circumstances, therefore, surgical treatment is an option reserved for patients in whom the inflamed sciatic nerve is the result of a problem with the spine (and not conditions such as the piriformis syndrome).

WHAT IS THE SURGICAL INTERVENTION?

Surgeries for the treatment of those diseases or those tumors of the spine associated with the inflamed 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, so as to cancel 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

Important home remedies against the inflamed sciatic nerve are:

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, alternative to 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

For those suffering from inflamed sciatic nerve, the prognosis depends mainly on the triggering factors: if the cause is treatable, the resulting sciatica 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 inflammation of the sciatic nerve presents very long healing times (we talk about months).

Prevention

Currently, preventing a condition like the inflamed sciatic nerve is impossible. However, by resorting to certain precautionary measures, the risk can be drastically reduced; that's how:

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 the inflamed sciatic nerve.