Every micron of the human body is permeated with the finest network of neural highways, coordinating super-complex activities of the whole organism. However, despite the paramount importance of the nervous system, it is a rather fragile structure that can, for one reason or another, “fail” and lead to the appearance of a neurological pathology.
It is this group of diseases that includes sciatic nerve inflammation, better known as sciatica.
Starting at the level of the sacro-lumbar spine, the sciatic nerve goes down and sends its branches to the hip, knee, ankle, shin, foot, and phalanges of the fingers. Thus, the sciatic nerve extends to the entire lower limb, providing it with sensitivity and mobility. However, it is an essential element of the sacral plexus, ensuring the normal functioning of all the organs of the pelvis.
The wide area of innervation by the sciatic nerve is closely connected with the peculiarities of the clinical manifestations of sciatica. Therefore, the symptoms of sciatica largely depend on where in the nerve root a pathological change has occurred.
The leading manifestations of sciatica are
- lower extremity pain
- impaired sensitivity and motor activity of the lower extremities.
These symptoms differ in localization, severity, nature and duration. For example, pain in nature can be shooting, burning, stabbing, aching, or pulling. Another characteristic of sciatica is the paroxysmal pain, when periods of increased pain alternate with a temporary weakening or even complete “lull”.
As a rule, pains are of a descending nature, arising first in the lumbar region and gradually descending to the lower parts, up to the tips of the fingers. Painful sensations mainly arise only in one leg, but with bilateral sciatica, both limbs are involved in the pathological process, turning the patient’s life into agonizing suffering. Especially when the pain is so intense that it almost paralyzes the patient: during such attacks, any movement, be it to try to sit down, stretch a leg, or simply transfer body weight from one leg to another, ends with a sharp exacerbation of pain.
At the same time, the symptoms of sciatica can be limited to only moderate, quite tolerable soreness, and sensitivity disorder becomes a priority, when numbness, tingling, and the feeling of “crawling” on one or another part of the body come to the fore.
Since the sciatic nerve provides the innervation of individual muscle groups, sciatica leads to a gradual weakening and even partial atrophy of some muscles. In particular, the patient may experience serious difficulties with flexing the tibia and raising the foot. In more severe cases, even urinary and fecal incontinence may develop as a result of the close interaction of the sciatic nerve with other peripheral pathways of the nervous system responsible for the functioning of the internal organs.
Since the symptoms of sciatica can be blurred and, moreover, they are often “masked” by manifestations of a concomitant disease, they do not play a major role in the diagnosis of inflammation of the sciatic nerve. Diagnosis of sciatica relies mainly on the clinical and neurological examination of the patient and the hardware and instrumental methods of research.
Clinical neurological examination consists primarily in determining the increased pain sensitivity when a patient performs certain actions. For example, if in the prone position to raise a straightened leg, then in the presence of sciatica in the lumbosacral region or along the affected nerve, severe pain arises, subsiding as the diseased limb subsides ( Lasegue test ). In the doctor’s arsenal, there are a number of similar tests that allow you to more accurately diagnose the disease (symptoms of Bechterew, Lerrey , Feerstein , etc.).
However, the doctor needs not so much to determine the fact of neuralgia of the sciatic nerve, as to find out the cause of its occurrence. Indeed, effective treatment of sciatica is possible only with the correct identification of the causative factor or, as doctors say, the etiology of the disease.
Treatment of sciatica cannot be successful without eliminating the underlying cause of this pathology. On the other hand, if all efforts are directed only at eliminating the cause, it will be inhuman to the patient, who at that time was suffering from severe pain. Therefore, treatment of sciatica should be comprehensive, aimed at the source of nerve damage, and clinical symptoms.
At the first stage, the patient is prescribed a conservative (non-surgical) treatment aimed at reducing the inflammatory process and alleviating painful attacks. For this purpose, both anti-inflammatory and anesthetic drugs are used, as well as physiotherapeutic procedures ( electrophoresis , UHF, magnetic therapy , etc.).
In addition, such conservative methods are widespread:
- manual therapy
- electrical muscle stimulation
- wearing fixing belts.
However, symptomatic treatment of sciatica only alleviates the patient’s condition, but does not cure him. To get rid of the disease finally, it is necessary to use etiotropic therapy in parallel, i.e. treatment aimed at the source of the disease. If sciatica is a consequence of the pathology of the pelvic organs, the underlying disease must be treated. If the sciatic nerve has suffered as a result of an attack by infectious pathogens, appropriate antibacterial or antiviral therapy is necessary.
Unfortunately, conservative treatment methods are not always effective. If sciatica occurs on the background of squeezing the nerve roots herniated intervertebral disc or tumor, surgical treatment of sciatica is inevitable.
The reasons for the development of sciatica can be quite a lot:
- spinal disorders
- infringement of nerve roots with a tumor,
- viral or toxic damage to the sciatic nerve, etc.
That is why more informative diagnostics is possible only when conducting hardware and instrumental studies. These include, first of all,
- X-ray examination
- computer and magnetic resonance imaging of the lumbosacral.
These studies very often allow you to quickly establish the source of pathology and immediately begin treatment of sciatica. As an additional diagnosis, showing the functional viability of the sciatic nerve, electroneuromyography is used , which makes it possible to assess how much the speed of nerve impulses has changed and after what period of time a muscular contraction occurs in response to nerve stimulation.
Since painful sensations accompany a huge number of various diseases, in order to avoid mistakes in diagnosis, in doubtful cases, they resort to the so-called differential diagnosis. Thus, ultrasonic doppler sonography, a method for studying blood flow in arteries and veins, allows sciatica to be distinguished from vascular origin. With sciatica, the vessels do not suffer, so naturally there is no change in blood flow.