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Sciatica and intervertebral disc prolapse

Introduction

The term sciatica describes a characteristic pain felt in the lower back, buttocks and the posterior and lower leg. It results from compression of any of the 5 nerve roots that contribute to the sciatic nerves (L4-S3).

  • Nerve Supplies
    • Femoral Nerve – L2-L4 – Anterior compartment of thigh
    • Sciatic Nerve – L4-S3 – Posterior compartment of thigh, plus the rest of the leg, including the foot
Most cases will resolve with conservative management within 12 weeks. Management is typically similar to that of mechanical back pain.

Physiology

Herniated intervertebral disc. Image by Servier Medical Art by Servier and is licensed under a Creative Commons Attribution 3.0 Unported License
Disc prolapse in situ – Image by Servier Medical Art by Servier and is licensed under a Creative Commons Attribution 3.0 Unported License

Pathology

 

Clinical presentation

Localisation with symptoms

However! – this is not always accurate. In 6% of cases, the herniation will occur laterally, and not posteriorly, and thus the exiting nerve, rather than the traversing nerve will be affected. E.g. a lateral herniation at L4/L5, will cause L4 symptoms.

Diagnosis

Is made on the basis of clinical signs

Management

90% will resolve spontaneously – the herniatied material will become dehydrated, and be reabsorbed.

In cases lasting longer than 12 weeks:

References

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