Skiathic is a medical condition marked by pain in the lower leg of the lower back. This pain can come back, outside, or front of the foot. Onset often suddenly follows activities such as weight lifting, although gradual onset may also occur. Usually, the symptoms are only on one side of the body. However, certain causes can cause pain on both sides. Lower back pain sometimes but not always present. Weakness or numbness can occur in different parts of affected legs and feet.
About 90% of the time of sciatica is due to spinal herniation pressing on one of the lumbar or sacral nerve roots. Other problems that can result in sciatica include spondylolisthesis, spinal stenosis, piriformis syndrome, pelvic tumor, and compression by the baby's head during pregnancy. A straight foot-lifting test often helps in diagnosis. The test is positive if, when the leg is raised when someone is lying on his back, the pain falls below the knee. In many cases, medical imaging is not necessary. The exception to this is when the function of the bowel or bladder is affected, there is a significant loss of feeling or weakness, long standing symptoms, or there are concerns of a tumor or infection. The conditions that may be present are similar to the initial hip and shing herpes zoster disease before the rash appears.
The initial treatment is usually with pain medication. It is generally recommended that people continue to do the best possible activity. Often all that's required is time: in about 90% of people the problem goes away in less than six weeks. If the pain is severe and lasts for more than six weeks then surgery may be an option. While surgery often speeds up the increase in pain, long-term benefits are unclear. Surgery may be necessary if complications occur such as bowel or bladder problems. Many treatments, including steroids, gabapentin, acupuncture, heat or ice, and spinal manipulation, have bad evidence for their use.
Depending on how it is defined, 2% to 40% of people experience sciatica at a time. This is most common at age 40 and 50 years, and men are more often affected than women. This condition has been known since ancient times. The first known usage of the word sciatica is from 1451.
Video Sciatica
Definisi
The term "sciatica" describes symptoms - pain along the sciatic nerve pathway - not a specific condition, disease, or disease. Some use it to interpret pain that begins in the lower back and down the legs. Others use the term more specifically to mean nerve dysfunction caused by compression of one or more lumbar or sacral nerve roots of spinal herniation. Although in this second use is a diagnosis (ie, it shows cause and effect). Pain usually occurs in the distribution of dermatomes and runs below the knee to the foot. It may be associated with neurological dysfunction, such as weakness. The pain is typical of this type of shooting, fast traveling along the course of the nerves.
Maps Sciatica
Cause
Spinal herniation
Spinal disc disc herniation that suppresses one of the lumbar or sacral nerve roots is the most common cause of sciatica, which is present in about 90% of cases.
Pelvic sciatica caused by pressure from disc herniation and surrounding tissue swelling can spontaneously subside if the tear in the disc heals and extrusion of the pulposus and inflammation stops.
Spinal stenosis
Other causes of spinal press include lumbar spine stenosis, a condition in which the spinal canal (spaces through which the spine) narrows and compresses the spinal cord, cauda equina, or nerve skiathic root. This narrowing can be caused by bone spurs, spondylolisthesis, inflammation, or herniated disc, which reduces the space available to the spinal cord, thus pinching and irritating the nerves of the spinal cord that run into the sciatic nerve.
Piriformis syndrome
Piriformis syndrome is a controversial condition that, depending on the analysis, varies from the cause of "very rare" to contribute up to 8% of back pain or buttocks. In 17% of the population, the sciatic nerve runs through the piriformis muscle rather than below it. When the muscle is shortened or seizures due to trauma or exaggeration, it suggests that this causes sciatic nerve compression. It has colloquially referred to as "sciatica wallet" because the wallet carried in the back hip pocket presses the buttocks muscle and the sciatic nerve when the carrier sits. Piriformis syndrome causes sciatica when the nerve root itself remains normal and no disc herniation of the spine is visible.
Pregnancy
Sciatica can also occur during pregnancy as a result of the weight of the fetus suppressing sciatic nerves during sitting or during a leg cramp. While most cases do not directly harm the fetus or the mother, indirect hazards may come from a numbing effect on the feet, which can lead to loss of balance and fall. There is no standard treatment for sciatica caused by pregnancy.
More
Sciatica can also be caused by a tumor that affects the spinal cord or nerve roots. Severe back pain extends to the hips and legs, loss of bladder or bowel control, or muscle weakness may result from spinal tumors or cauda equina syndrome. Trauma to the spine, such as from a car accident, can also cause sciatica. A relationship has been proposed with latent Propionibacterium acnes infection in the intervertebral disc, but the role it plays is unclear.
Pathophysiology
Sciatica is generally caused by lumbar nerve compression of L4, or L5 or the sacral nerves of S1, S2, or S3, or by a sciatic nerve compression itself. When sciatica is caused by compression of the dorsal nerve root (radix), it is considered a lumbar radiculopathy (or radiculitis when accompanied by an inflammatory response). This may occur as a result of spinal disc protrusion or spinal disc herniation (herniated intervertebral disc), or from roughness, enlargement, or misalignment ( spondylolisthesis ) of the vertebrae, or as a result of disc degeneration can reduce the diameter of the lateral foramen (natural hole) through the nerve roots coming out of the spine. The intervertebral disc is composed of the annulus fibrosus, which forms a ring around the nucleus of the pulposus cell. When there is a tear in the annulus fibrosus, the nucleus pulposus (pulp) can secrete through the tears and compress the spinal cord within the spinal cord, cauda equina, or out of the nerve roots, causing inflammation, numbness, or extreme pain. Inflammation of the spinal canal can also spread to adjacent facet joints and cause lower back pain and/or pain referred to the posterior thigh. Pseudosciatic pain can also be caused by compression of peripheral nerve passages, usually from soft tissue tension in the piriformis or associated muscles.
The spine disc consists of a strong cartilage ring ("annulus fibrosus") with a softer center ("nucleus pulposus"). The disc separates the spine, allowing space for the nerve root to exit properly through the space between the spine. Spinal cuff discs of compressive force, but weak for pressure applied during rotation motion. That's why someone who bends to one side, with a bad angle to grab something, may be more likely to experience a spinal disc disc herniation than someone who jumps off a ladder and lands on their feet.
Disc herniation occurs when the center of the disk fluid protrudes outward, tearing the outer ring of fibers, removing into the spinal canal, and suppressing the nerve roots of the lamina or pedicle of the vertebra, causing sciatica. This extruded fluid from the "nucleus pulposus" can cause inflammation and swelling of surrounding tissue, which can lead to further compression of the nerve roots in confined spaces in the spinal canal. Many of the herniated discs themselves, however, do not cause pain or discomfort: only occasional herniation causes sciatica.
Diagnosis
Sciatica is usually diagnosed with a physical examination, and a history of symptoms. Generally if a person reports a typical radiating pain in one leg as well as one or more neurological indications of nerve root tension or neurological deficits, sciatica can be diagnosed.
The most widely applied diagnostic test is the improvement of straight legs to produce a LasÃÆ'¨gue sign, which is considered positive if pain in the sciatic nerve distribution is reproduced with passive flexion of straight legs between 30 and 70 degrees. While the test is positive in about 90% of people with sciatica, about 75% of people with positive tests do not have sciatica.
Imaging tests such as computerized tomography or magnetic resonance imaging can help diagnose lumbar disc herniation. The utility of MR neurography in the diagnosis of piriformis syndrome is controversial.
Management
When the cause of sciatica is a lumbar disc herniation, most cases disappear spontaneously for several weeks to months. Initially treatment within the first 6-8 weeks should be conservative. There seems to be no significant difference between suggestions for staying active and break recommendations. Similarly, physical therapy (directional training) has not been found to be better than bed rest.
Drugs
Drugs are usually prescribed for the treatment of sciatica, but evidence for pain medication is bad. In particular, low-quality evidence suggests that NSAIDs do not appear to correct pain soon and all NSAIDs appear around equivalent. Evidence is also lacking in the use of opioids and muscle relaxants in the usual way. In those with sciatica due to piriformis syndrome, botulinum toxin injections can improve pain and or function. There is little evidence for steroids, either epidural or with pills. Low quality evidence supports the use of gabapentin for acute pain relief in patients with chronic sciatica.
Surgery
Surgery for unilateral sciatica involves the removal of parts of the disk, known as discectomy. Despite generating short-term benefits, long-term benefits seem to be equivalent to conservative care. Treatment of the underlying cause of compression is necessary in cases of epidural abscess, epidural tumor, and cauda equina syndrome.
Alternative medicine
Low to moderate quality evidence suggests that spinal manipulation is an effective treatment for acute sciatica. For chronic sciatica, the evidence is bad. Spinal manipulation has been found to be generally safe for the treatment of pain-related disks; However, case reports have found association with cauda equina syndrome, and are contraindicated when there is progressive neurologic deficit.
Epidemiology
Depending on how it is defined, 2% to 40% of people experience sciatica at a time. This is most common in the 40s and 50s and men are more affected than women.
References
External links
Source of the article : Wikipedia
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