Sciatica
Definition
- Pain radiating from back to buttock to back of thigh to calf is sciatica
- Pain in sciatic neeve region / dermatome is sciatica
- Leg pain from buttock to calf
Causes :-
Multiple causes can create sciatica
- SPINAL CAUSES ( Common )
- Slip Disc / herniated disc / disc bulge one of commonest commonest cause -pain and paresthesiae in dermatomal pattern
- Nerve compression due to Degenerative facet arthritis /canal stenosis or some progressive disease like infection / TB / Tumor can present as sciatica. – In disease related sciatica the pain is not activity related and is usually present even at rest.
EXTRASPINAL CAUSES (Not uncommon)
- Sacroillitis – one of the common causes usually missed in diagnosis
- Hip pathologies – AVN, hip OA
- Peripheral neuropathy
- Visceral and vascular insufficiency
- Reffered pain
Most of these may mimic like sciatica as pain is in same location but cause is extraspinal.
THUMB RULE For Management
- Always examine and take detailed history to rule out exact cause and differentiate spinal vs extraspinal cause of sciatica
- History taking and clinical examination is the best mode to establish near confirmed diagnosis
- Conservative treatment with medication and physiotherapy under supervision – usually helps in degenrative pathology with no neurology deficit
- Surgery may be required in small subset of patients progressive symptoms with neurology
- MICROENDOSCOPIC SURGERY – MINIMAL INVASIVE SPINE SURGERY – is extremely safe simple and predictive with promising results and least bed rest/ hospital stay
