Sciatica

Last updated
Sciatica
Other namesSciatic neuritis, sciatic neuralgia, lumbar radiculopathy, radicular leg pain
Sciatic nerve2.jpg
Anterior view showing the sciatic nerve going down the right leg
Pronunciation
Specialty Orthopedics, neurology
Symptoms Pain going down the leg from the lower back, weakness or numbness of the affected leg [1]
Complications Loss of bowel or bladder control [2]
Usual onset40s–50s [2] [3]
Duration90% of the time less than 6 weeks [2]
Causes Spinal disc herniation, spondylolisthesis, spinal stenosis, piriformis syndrome, pelvic tumor [3] [4]
Diagnostic method Straight-leg-raising test [3]
Differential diagnosis Shingles, diseases of the hip [3]
Treatment Pain medications, surgery, [2] physical rehabilitation
Frequency2–40% of people at some time [4]

Sciatica is pain going down the leg from the lower back. [1] This pain may go down the back, outside, or front of the leg. [3] Onset is often sudden following activities like heavy lifting, though gradual onset may also occur. [5] The pain is often described as shooting. [1] Typically, symptoms are only on one side of the body. [3] Certain causes, however, may result in pain on both sides. [3] Lower back pain is sometimes present. [3] Weakness or numbness may occur in various parts of the affected leg and foot. [3]

Contents

About 90% of sciatica is due to a spinal disc herniation pressing on one of the lumbar or sacral nerve roots. [4] Spondylolisthesis, spinal stenosis, piriformis syndrome, pelvic tumors, and pregnancy are other possible causes of sciatica. [3] The straight-leg-raising test is often helpful in diagnosis. [3] The test is positive if, when the leg is raised while a person is lying on their back, pain shoots below the knee. [3] In most cases medical imaging is not needed. [2] However, imaging may be obtained if bowel or bladder function is affected, there is significant loss of feeling or weakness, symptoms are long standing, or there is a concern for tumor or infection. [2] Conditions that may present similarly are diseases of the hip and infections such as early shingles (prior to rash formation). [3]

Initial treatment typically involves pain medications. [2] However, evidence for effectiveness of the pain medication and muscle relaxants is lacking. [6] It is generally recommended that people continue with normal activity to the best of their abilities. [3] Often all that is required for sciatica resolution is time; in about 90% of people symptoms resolve in less than six weeks. [2] If the pain is severe and lasts for more than six weeks, surgery may be an option. [2] While surgery often speeds pain improvement, its long term benefits are unclear. [3] Surgery may be required if complications occur, such as loss of normal bowel or bladder function. [2] Many treatments, including corticosteroids, gabapentin, pregabalin, acupuncture, heat or ice, and spinal manipulation, have limited or poor evidence for their use. [3] [7] [8]

Depending on how it is defined, less than 1% to 40% of people have sciatica at some point in time. [4] [9] Sciatica is most common between the ages of 40 and 59, and men are more frequently affected than women. [2] [3] The condition has been known since ancient times. [3] The first known modern use of the word sciatica dates from 1451, [10] although Dioscorides (1st-century CE) mentions it in his Materia Medica . [11]

Definition

Sciatica often results in pain radiating down the leg. Sciatica.jpg
Sciatica often results in pain radiating down the leg.

The term "sciatica" usually describes a symptom—pain along the sciatic nerve pathway—rather than a specific condition, illness, or disease. [4] Some use it to mean any pain starting in the lower back and going down the leg. [4] The pain is characteristically described as shooting or shock-like, quickly traveling along the course of the affected nerves. [12] Others use the term as a diagnosis (i.e. an indication of cause and effect) for nerve dysfunction caused by compression of one or more lumbar or sacral nerve roots from a spinal disc herniation. [4] Pain typically occurs in the distribution of a dermatome and goes below the knee to the foot. [4] [6] It may be associated with neurological dysfunction, such as weakness and numbness. [4]

Causes

Risk factors

Modifiable risk factors for sciatica include smoking, obesity, occupation, [9] and physical sports where back muscles and heavy weights are involved. Non-modifiable risk factors include increasing age, being male, and having a personal history of low back pain. [9]

Spinal disc herniation

Spinal disc herniation pressing on one of the lumbar or sacral nerve roots is the most frequent cause of sciatica, being present in about 90% of cases. [4] This is particularly true in those under age 50. [13] Disc herniation most often occurs during heavy lifting. [14] Pain typically increases when bending forward or sitting, and reduces when lying down or walking. [13]

Spinal stenosis

Other compressive spinal causes include lumbar spinal stenosis, a condition in which the spinal canal, the space the spinal cord runs through, narrows and compresses the spinal cord, cauda equina, or sciatic nerve roots. [15] This narrowing can be caused by bone spurs, spondylolisthesis, inflammation, or a herniated disc, which decreases available space for the spinal cord, thus pinching and irritating nerves from the spinal cord that become the sciatic nerve. [15] This is the most frequent cause after age 50. [13] Sciatic pain due to spinal stenosis is most commonly brought on by standing, walking, or sitting for extended periods of time, and reduces when bending forward. [13] [15] However, pain can arise with any position or activity in severe cases. [15] The pain is most commonly relieved by rest. [15]

Piriformis syndrome

Piriformis syndrome is a condition that, depending on the analysis, varies from a "very rare" cause to contributing up to 8% of low back or buttock pain. [16] In 17% of people, the sciatic nerve runs through the piriformis muscle rather than beneath it. [15] When the piriformis shortens or spasms due to trauma or overuse, it is posited that this causes compression of the sciatic nerve. [16] Piriformis syndrome has colloquially been referred to as "wallet sciatica" since a wallet carried in a rear hip pocket compresses the buttock muscles and sciatic nerve when the bearer sits down. Piriformis syndrome may be suspected as a cause of sciatica when the spinal nerve roots contributing to the sciatic nerve are normal and no herniation of a spinal disc is apparent. [17] [18]

Deep gluteal syndrome

Deep gluteal syndrome is non-discogenic, extrapelvic sciatic nerve entrapment in the deep gluteal space. [19] Piriformis syndrome was once the traditional model of sciatic nerve entrapment in this anatomic region. The understanding of non-discogenic sciatic nerve entrapment has changed significantly with improved knowledge of posterior hip anatomy, nerve kinematics, and advances in endoscopic techniques to explore the sciatic nerve. [20] [21] There are now many known causes of sciatic nerve entrapment, such as fibrous bands restricting nerve mobility, that are unrelated to the piriformis in the deep gluteal space. Deep gluteal syndrome was created as an improved classification for the many distinct causes of sciatic nerve entrapment in this anatomic region. [21] Piriformis syndrome is now considered one of many causes of deep gluteal syndrome. [20]

Endometriosis

Sciatic endometriosis, also called catamenial or cyclical sciatica, is a sciatica whose cause is endometriosis. Its incidence is unknown. Diagnosis is usually made by an MRI or CT-myelography. [22]

Pregnancy

Sciatica may also occur during pregnancy, especially during later stages, as a result of the weight of the fetus pressing on the sciatic nerve during sitting or during leg spasms. [15] While most cases do not directly harm the woman or the fetus, indirect harm may come from the numbing effect on the legs, which can cause loss of balance and falls. There is no standard treatment for pregnancy-induced sciatica. [23]

Other

Pain that does not improve when lying down suggests a nonmechanical cause, such as cancer, inflammation, or infection. [13] Sciatica can be caused by tumors impinging on the spinal cord or the nerve roots. [4] Severe back pain extending to the hips and feet, loss of bladder or bowel control, or muscle weakness may result from spinal tumors or cauda equina syndrome. [15] Trauma to the spine, such as from a car accident or hard fall onto the heel or buttocks, may also lead to sciatica. [15] A relationship has been proposed with a latent Cutibacterium acnes infection in the intervertebral discs, but the role it plays is not yet clear. [24] [25]

Pathophysiology

The sciatic nerve comprises nerve roots L4, L5, S1, S2, and S3 in the spine. [26] These nerve roots merge in the pelvic cavity to form the sacral plexus and the sciatic nerve branches from that. Sciatica symptoms can occur when there is pathology anywhere along the course of these nerves. [27]

Intraspinal sciatica

Left: Illustration of herniated spinal disc, superior view. Right: MRI showing herniated L5-S1 disc (red arrow tip), sagittal view. 728 Herniated Disk.jpg
Left: Illustration of herniated spinal disc, superior view. Right: MRI showing herniated L5-S1 disc (red arrow tip), sagittal view.

Intraspinal, or discogenic sciatica refers to sciatica whose pathology involves the spine. In 90% of sciatica cases, this can occur as a result of a spinal disc bulge or herniation. [14] [28] Sciatica is generally caused by the compression of lumbar nerves L4 or L5 or sacral nerve S1. [29] Less commonly, sacral nerves S2 or S3 may cause sciatica. [29]

Intervertebral spinal discs consist of an outer anulus fibrosus and an inner nucleus pulposus. [14] The anulus fibrosus forms a rigid ring around the nucleus pulposus early in human development, and the gelatinous contents of the nucleus pulposus are thus contained within the disc. [14] Discs separate the spinal vertebrae, thereby increasing spinal stability and allowing nerve roots to properly exit through the spaces between the vertebrae from the spinal cord. [30] As an individual ages, the anulus fibrosus weakens and becomes less rigid, making it at greater risk for tear. [14] When there is a tear in the anulus fibrosus, the nucleus pulposus may extrude through the tear and press against spinal nerves within the spinal cord, cauda equina, or exiting nerve roots, causing inflammation, numbness, or excruciating pain. [31] Inflammation of spinal tissue can then spread to adjacent facet joints and cause facet syndrome, which is characterized by lower back pain and referred pain in the posterior thigh. [14]

Other causes of sciatica secondary to spinal nerve entrapment include the roughening, enlarging, or misalignment ( spondylolisthesis ) of vertebrae, or disc degeneration that reduces the diameter of the lateral foramen through which nerve roots exit the spine. [14] When sciatica is caused by compression of a dorsal nerve root, it is considered a lumbar radiculopathy or radiculitis when accompanied by an inflammatory response. [15]

Extraspinal sciatica

Illustration of fibrovascular bands restricting mobility of the sciatic nerve in multiple directions, like a splattering of glue Fibrovascular entrapment of the sciatic nerve undefined distribution.jpg
Illustration of fibrovascular bands restricting mobility of the sciatic nerve in multiple directions, like a splattering of glue

The sciatic nerve is highly mobile during hip and leg movements. [32] [33] Any pathology which restricts normal movement of the sciatic nerve can put abnormal pressure, strain, or tension on the nerve in certain positions or during normal movements. For example, the presence of scar tissue around a nerve can cause traction neuropathy. [34]

A well known muscular cause of extraspinal sciatica is piriformis syndrome. The piriformis muscle is directly adjacent to the course of the sciatic nerve as it traverses through the intrapelvic space. Pathologies of the piriformis muscle such as injury (e.g. swelling and scarring), inflammation (release of cytokines affecting the local cellular environment), or space occupying lesions (e.g. tumor, cyst, hypertrophy) can affect the sciatic nerve. [35] Anatomic variations in nerve branching can also predispose the sciatic nerve to further compression by the piriformis muscle, such as if the sciatic nerve pierces the piriformis muscle. [36]

The sciatic nerve can also be entrapped outside of the pelvic space and this is called deep gluteal syndrome. [19] Surgical research has identified new causes of entrapment such as fibrovascular scar bands, vascular abnormalities, heterotropic ossification, gluteal muscles, hamstring muscles, and the gemelli-obturator internus complex. [20] In almost half of the endoscopic surgery cases, fibrovascular scar bands were found to be the cause of entrapment, impeding the movement of the sciatic nerve. [37] [38]

Diagnosis

Straight leg test sometimes used to help diagnose a lumbar herniated disc Straight-leg-test.gif
Straight leg test sometimes used to help diagnose a lumbar herniated disc

Sciatica is typically diagnosed by physical examination, and the history of the symptoms. [4]

Physical tests

Generally, if a person reports the typical radiating pain in one leg, as well as one or more neurological indications of nerve root tension or neurological deficit, sciatica can be diagnosed. [6]

The most frequently used diagnostic test is the straight leg raise to produce Lasègue's sign, which is considered positive if pain in the distribution of the sciatic nerve is reproduced with passive flexion of the straight leg between 30 and 70 degrees. [39] While this test is positive in about 90% of people with sciatica, approximately 75% of people with a positive test do not have sciatica. [4] Straight leg raising of the leg unaffected by sciatica may produce sciatica in the leg on the affected side; this is known as the Fajersztajn sign. [15] The presence of the Fajersztajn sign is a more specific finding for a herniated disc than Lasègue's sign. [15] Maneuvers that increase intraspinal pressure, such as coughing, flexion of the neck, and bilateral compression of the jugular veins, may transiently worsen sciatica pain. [15]

Medical imaging

Imaging modalities such as computerised tomography or magnetic resonance imaging can help with the diagnosis of lumbar disc herniation. [40] Both are equally effective at diagnosing lumbar disk herniation, but computerized tomography has a higher radiation dose. [6] Radiography is not recommended because disks cannot be visualized by X-rays. [6] The utility of MR neurography in the diagnosis of piriformis syndrome is controversial. [16]

Discography could be considered to determine a specific disc's role in an individual's pain. [14] Discography involves the insertion of a needle into a disc to determine the pressure of disc space. [14] Radiocontrast is then injected into the disc space to assess for visual changes that may indicate an anatomic abnormality of the disc. [14] The reproduction of an individual's pain during discography is also diagnostic. [14]

Differential diagnosis

Cancer should be suspected if there is previous history of it, unexplained weight loss, or unremitting pain. [13] Spinal epidural abscess is more common among those who have diabetes mellitus or immunodeficiency, or who have had spinal surgery, injection or catheter; it typically causes fever, leukocytosis and increased erythrocyte sedimentation rate. [13] If cancer or spinal epidural abscess is suspected, urgent magnetic resonance imaging is recommended for confirmation. [13] Proximal diabetic neuropathy typically affects middle aged and older people with well-controlled type-2 diabetes mellitus; onset is sudden, causing pain, usually in multiple dermatomes, quickly followed by weakness. Diagnosis typically involves electromyography and lumbar puncture. [13] Shingles is more common among the elderly and immunocompromised; typically, pain is followed by the appearance of a rash with small blisters along a single dermatome. [13] [41] Acute Lyme radiculopathy may follow a history of outdoor activities during warmer months in likely tick habitats in the previous 1–12 weeks. [42] In the U.S., Lyme is most common in New England and Mid-Atlantic states and parts of Wisconsin and Minnesota, but it is expanding to other areas. [43] [44] The first manifestation is usually an expanding rash possibly accompanied by flu-like symptoms. [45] Lyme can also cause a milder, chronic radiculopathy an average of 8 months after the acute illness. [13]

Management

Sciatica can be managed with a number of different treatments [46] with the goal of restoring a person's normal functional status and quality of life. [14] When the cause of sciatica is lumbar disc herniation (90% of cases), [4] most cases resolve spontaneously over weeks to months. [47] Initially treatment in the first 6–8 weeks should be conservative. [4] More than 75% of sciatica cases are managed without surgery. [14] Smokers with sciatica are strongly urged to quit in order to promote healing. [14] Treatment of the underlying cause of nerve compression is needed in cases of epidural abscess, epidural tumors, and cauda equina syndrome. [14]

Physical activity

Physical activity is often recommended for the conservative management of sciatica for persons who are physically able. [3] Bed rest is not recommended. [48] Although structured exercises provide small, short-term benefit for leg pain, in the long term no difference is seen between exercise or simply staying active. [49] The evidence for physical therapy in sciatica is unclear though such programs appear safe. [3] Physical therapy is commonly used. [3] Nerve mobilization techniques for sciatic nerve are supported by tentative evidence. [50]

Medication

There is no one medication regimen used to treat sciatica. [46] Evidence supporting the use of opioids and muscle relaxants is poor. [51] Low-quality evidence indicates that NSAIDs do not appear to improve immediate pain, and all NSAIDs appear to be nearly equivalent in their ability to relieve sciatica. [51] [52] [53] Nevertheless, NSAIDs are commonly recommended as a first-line treatment for sciatica. [46] In those with sciatica due to piriformis syndrome, botulinum toxin injections may improve pain and function. [54] While there is little evidence supporting the use of epidural or systemic steroids, [55] [56] systemic steroids may be offered to individuals with confirmed disc herniation if there is a contraindication to NSAID use. [46] Low-quality evidence supports the use of gabapentin for acute pain relief in those with chronic sciatica. [51] Anticonvulsants and biologics have not been shown to improve acute or chronic sciatica. [46] Antidepressants have demonstrated some efficacy in treating chronic sciatica, and may be offered to individuals who are not amenable to NSAIDs or who have failed NSAID therapy. [46]

Surgery

If sciatica is caused by a herniated disc, the disc's partial or complete removal, known as a discectomy, has tentative evidence of benefit in the short term. [57] A modest reduction in pain is seen after 26 weeks, but not after one year (about 52 weeks). [48] If the cause is spondylolisthesis or spinal stenosis, surgery appears to provide pain relief for up to two years. [57]

For non-discogenic sciatica, the surgical treatment is typically a nerve decompression. A decompression seeks to remove tissue around the nerve that may be compressing it or restricting movement of the nerve. [58] [59] [60]

Alternative medicine

Low to moderate-quality evidence suggests that spinal manipulation is an effective treatment for acute sciatica. [3] [61] For chronic sciatica, the evidence supporting spinal manipulation as treatment is poor. [61] Spinal manipulation has been found generally safe for the treatment of disc-related pain; however, case reports have found an association with cauda equina syndrome, [62] and it is contraindicated when there are progressive neurological deficits. [63]

Prognosis

About 39% to 50% of people with sciatica still have symptoms after one to four years. [64] In one study, around 20% were unable to work at their one-year followup, and 10% had surgery for the condition. [64]

Epidemiology

Depending on how it is defined, less than 1% to 40% of people have sciatica at some point in time. [9] [4] Sciatica is most common between the ages of 40 and 59, and men are more frequently affected than women. [2] [3]

See also

Related Research Articles

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Lumbar disc disease is the drying out of the spongy interior matrix of an intervertebral disc in the spine. Many physicians and patients use the term lumbar disc disease to encompass several different causes of back pain or sciatica. In this article, the term is used to describe a lumbar herniated disc. It is thought that lumbar disc disease causes about one-third of all back pain.

<span class="mw-page-title-main">Sciatic nerve</span> Large nerve in humans and other animals

The sciatic nerve, also called the ischiadic nerve, is a large nerve in humans and other vertebrate animals. It is the largest branch of the sacral plexus and runs alongside the hip joint and down the lower limb. It is the longest and widest single nerve in the human body, going from the top of the leg to the foot on the posterior aspect. The sciatic nerve has no cutaneous branches for the thigh. This nerve provides the connection to the nervous system for the skin of the lateral leg and the whole foot, the muscles of the back of the thigh, and those of the leg and foot. It is derived from spinal nerves L4 to S3. It contains fibres from both the anterior and posterior divisions of the lumbosacral plexus.

<span class="mw-page-title-main">Lumbar</span> Abdominal segment of the torso

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<span class="mw-page-title-main">Spondylosis</span> Degeneration of the vertebral column

Spondylosis is the degeneration of the vertebral column from any cause. In the more narrow sense, it refers to spinal osteoarthritis, the age-related degeneration of the spinal column, which is the most common cause of spondylosis. The degenerative process in osteoarthritis chiefly affects the vertebral bodies, the neural foramina and the facet joints. If severe, it may cause pressure on the spinal cord or nerve roots with subsequent sensory or motor disturbances, such as pain, paresthesia, imbalance, and muscle weakness in the limbs.

<span class="mw-page-title-main">Piriformis muscle</span> Hip muscle in the lateral rotator group

The piriformis muscle is a flat, pyramidally-shaped muscle in the gluteal region of the lower limbs. It is one of the six muscles in the lateral rotator group.

<span class="mw-page-title-main">Piriformis syndrome</span> Medical condition

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<span class="mw-page-title-main">Degenerative disc disease</span> Loss of function in the spines intervertebral discs

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<span class="mw-page-title-main">Cauda equina syndrome</span> Nerve damage at the end of the spinal cord

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<span class="mw-page-title-main">Disc herniation</span> Injury to the intervertebral disc

A spinal disc herniation or simply a disc herniation is an injury to the intervertebral disc between two spinal vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physical disability. The most conclusive diagnostic tool for disc herniation is MRI, and treatments may range from painkillers to surgery. Protection from disc herniation is best provided by core strength and an awareness of body mechanics including good posture.

<span class="mw-page-title-main">Radiculopathy</span> Medical condition

Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly. Radiculopathy can result in pain, weakness, altered sensation (paresthesia) or difficulty controlling specific muscles. Pinched nerves arise when surrounding bone or tissue, such as cartilage, muscles or tendons, put pressure on the nerve and disrupt its function.

<span class="mw-page-title-main">Superior cluneal nerves</span> Sensory nerves

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<span class="mw-page-title-main">Magnetic resonance neurography</span>

Magnetic resonance neurography (MRN) is the direct imaging of nerves in the body by optimizing selectivity for unique MRI water properties of nerves. It is a modification of magnetic resonance imaging. This technique yields a detailed image of a nerve from the resonance signal that arises from in the nerve itself rather than from surrounding tissues or from fat in the nerve lining. Because of the intraneural source of the image signal, the image provides a medically useful set of information about the internal state of the nerve such as the presence of irritation, nerve swelling (edema), compression, pinch or injury. Standard magnetic resonance images can show the outline of some nerves in portions of their courses but do not show the intrinsic signal from nerve water. Magnetic resonance neurography is used to evaluate major nerve compressions such as those affecting the sciatic nerve (e.g. piriformis syndrome), the brachial plexus nerves (e.g. thoracic outlet syndrome), the pudendal nerve, or virtually any named nerve in the body. A related technique for imaging neural tracts in the brain and spinal cord is called magnetic resonance tractography or diffusion tensor imaging.

<span class="mw-page-title-main">Nerve compression syndrome</span> Symptoms resulting from chronic, direct pressure on a peripheral nerve

Nerve compression syndrome, or compression neuropathy, or nerve entrapment syndrome, is a medical condition caused by chronic, direct pressure on a peripheral nerve. It is known colloquially as a trapped nerve, though this may also refer to nerve root compression. Its symptoms include pain, tingling, numbness and muscle weakness. The symptoms affect just one particular part of the body, depending on which nerve is affected. The diagnosis is largely clinical and can be confirmed with diagnostic nerve blocks. Occasionally imaging and electrophysiology studies aid in the diagnosis. Timely diagnosis is important as untreated chronic nerve compression may cause permanent damage. A surgical nerve decompression can relieve pressure on the nerve but cannot always reverse the physiological changes that occurred before treatment. Nerve injury by a single episode of physical trauma is in one sense an acute compression neuropathy but is not usually included under this heading, as chronic compression takes a unique pathophysiological course.

<span class="mw-page-title-main">Spinal stenosis</span> Disease of the bony spine that results in narrowing of the spinal canal

Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with leaning forward. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.

A nerve decompression is a neurosurgical procedure to relieve chronic, direct pressure on a nerve to treat nerve entrapment, a pain syndrome characterized by severe chronic pain and muscle weakness. In this way a nerve decompression targets the underlying pathophysiology of the syndrome and is considered a first-line surgical treatment option for peripheral nerve pain. Despite treating the underlying cause of the disease, the symptoms may not be fully reversible as delays in diagnosis can allow permanent damage to occur to the nerve and surrounding microvasculature. Traditionally only nerves accessible with open surgery have been good candidates, however innovations in laparoscopy and nerve-sparing techniques made nearly all nerves in the body good candidates, as surgical access is no longer a barrier.

<span class="mw-page-title-main">Deep gluteal syndrome</span> Medical condition

Deep gluteal syndrome describes the non-discogenic extrapelvic entrapment of the sciatic nerve in the deep gluteal space. In simpler terms this is sciatica due to nerve irritation in the buttocks rather than the spine or pelvis. It is an extension of non-discogenic sciatic nerve entrapment beyond the traditional model of piriformis syndrome. Where sciatic nerve irritation in the buttocks was once thought of as only piriformis muscle, it is now recognized that there are many other causes. Symptoms are pain or dysthesias in the buttocks, hip, and posterior thigh with or without radiating leg pain. Patients often report pain when sitting. The two most common causes are piriformis syndrome and fibrovascular bands, but many other causes exist. Diagnosis is usually done through physical examination, magnetic resonance imaging, magnetic resonance neurography, and diagnostic nerve blocks. Surgical treatment is an endoscopic sciatic nerve decompression where tissue around the sciatic nerve is removed to relieve pressure.

References

  1. 1 2 3 "Sciatica". Archived from the original on 7 March 2018. Retrieved 2 July 2015.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 Institute for Quality and Efficiency in Health Care (October 9, 2014). "Slipped disk: Overview". Archived from the original on 8 September 2017. Retrieved 2 July 2015.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Ropper, AH; Zafonte, RD (26 March 2015). "Sciatica". The New England Journal of Medicine. 372 (13): 1240–8. doi:10.1056/NEJMra1410151. PMID   25806916.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Valat, JP; Genevay, S; Marty, M; Rozenberg, S; Koes, B (April 2010). "Sciatica". Best Practice & Research. Clinical Rheumatology. 24 (2): 241–52. doi:10.1016/j.berh.2009.11.005. PMID   20227645.
  5. ↑ T.J. Fowler; J.W. Scadding (28 November 2003). Clinical Neurology, 3Ed. CRC. p. 59. ISBN   978-0-340-80798-9.
  6. 1 2 3 4 5 Koes BM, vanTulder, HW, Peul WC (2007). "Diagnosis and treatment of sciatica". The BMJ . 334 (7607): 1313. doi:10.1136/bmj.39223.428495.BE. PMC   1895638 . PMID   17585160.
  7. ↑ Markova, Tsvetio (2007). "Treatment of Acute Sciatica". Am Fam Physician. 75 (1): 99–100. PMID   17225710. Archived from the original on 2016-02-02.
  8. ↑ Enke O, New HA, New CH, Mathieson S, McLachlan AJ, Latimer J, Maher CG, Lin CC (July 2018). "Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis". CMAJ. 190 (26): E786–E793. doi:10.1503/cmaj.171333. PMC   6028270 . PMID   29970367.
  9. 1 2 3 4 Cook CE, Taylor J, Wright A, Milosavljevic S, Goode A, Whitford M (June 2014). "Risk factors for first time incidence sciatica: a systematic review". Physiother Res Int. 19 (2): 65–78. doi:10.1002/pri.1572. PMID   24327326.
  10. ↑ Simpson, John (2009). Oxford English dictionary (2nd ed.). Oxford: Oxford University Press. ISBN   978-0199563838.
  11. ↑ Dioscorides, Materia Medica (2-184, s.v. Sinepi), p. 311
  12. ↑ Bhat, Sriram (2013). SRB's Manual of Surgery. p. 364. ISBN   9789350259443.
  13. 1 2 3 4 5 6 7 8 9 10 11 Tarulli AW, Raynor EM (May 2007). "Lumbosacral radiculopathy" (PDF). Neurologic Clinics. 25 (2): 387–405. doi:10.1016/j.ncl.2007.01.008. PMID   17445735. S2CID   15518713. Archived from the original (PDF) on 2019-02-20.
  14. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Butterworth IV, John F. (2013). Morgan & Mikhail's Clinical Anesthesiology. David C. Mackey, John D. Wasnick (5th. ed.). New York: McGraw-Hill. pp. Chapter 47. Chronic Pain Management. ISBN   9780071627030. OCLC   829055521.
  15. 1 2 3 4 5 6 7 8 9 10 11 12 13 Ropper, Allan H. (2014). Adams and Victor's Principles of Neurology. Samuels, Martin A., Klein, Joshua P. (Tenth ed.). New York. pp. Chapter 11. Pain in the Back, Neck, and Extremities. ISBN   9780071794794. OCLC   857402060.{{cite book}}: CS1 maint: location missing publisher (link)
  16. 1 2 3 Miller TA, White KP, Ross DC (September 2012). "The diagnosis and management of Piriformis Syndrome: myths and facts". Can J Neurol Sci. 39 (5): 577–83. doi: 10.1017/s0317167100015298 . PMID   22931697.
  17. ↑ Kirschner JS, Foye PM, Cole JL (July 2009). "Piriformis syndrome, diagnosis and treatment". Muscle Nerve. 40 (1): 10–18. doi:10.1002/mus.21318. PMID   19466717. S2CID   19857216.
  18. ↑ Lewis AM, Layzer R, Engstrom JW, Barbaro NM, Chin CT (October 2006). "Magnetic resonance neurography in extraspinal sciatica". Arch. Neurol. 63 (10): 1469–72. doi:10.1001/archneur.63.10.1469. PMID   17030664. S2CID   6634301.
  19. 1 2 Kizaki K, Uchida S, Shanmugaraj A, Aquino CC, Duong A, Simunovic N, Martin HD, Ayeni OR (October 2020). "Deep gluteal syndrome is defined as a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space: a systematic review". Knee Surg Sports Traumatol Arthrosc. 28 (10): 3354–3364. doi:10.1007/s00167-020-05966-x. PMID   32246173. S2CID   214784014.
  20. 1 2 3 Martin HD, Reddy M, Gómez-Hoyos J (July 2015). "Deep gluteal syndrome". J Hip Preserv Surg. 2 (2): 99–107. doi:10.1093/jhps/hnv029. PMC   4718497 . PMID   27011826.
  21. 1 2 Hernando MF, Cerezal L, Pérez-Carro L, Abascal F, Canga A (July 2015). "Deep gluteal syndrome: anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space". Skeletal Radiol. 44 (7): 919–34. doi:10.1007/s00256-015-2124-6. PMID   25739706.
  22. ↑ Gandhi, Jason; Wilson, Anthony L; Liang, Raymond; Weissbart, Steven J; Khan, Sardar Ali (2020-11-11). "Sciatic endometriosis: A narrative review of an unusual neurogynecologic condition". Journal of Endometriosis and Pelvic Pain Disorders. 13 (1). SAGE Publications: 3–9. doi:10.1177/2284026520970813. ISSN   2284-0265. S2CID   228834273.
  23. ↑ Sciatic Nerve Pain During Pregnancy: Causes and Treatment. American Pregnancy Association. Published September 20, 2017. Accessed November 12, 2018.
  24. ↑ Ganko R, Rao PJ, Phan K, Mobbs RJ (May 2015). "Can bacterial infection by low virulent organisms be a plausible cause for symptomatic disc degeneration? A systematic review". Spine. 40 (10): E587–92. doi:10.1097/BRS.0000000000000832. PMID   25955094. S2CID   23436352.
  25. ↑ Chen Z, Cao P, Zhou Z, Yuan Y, Jiao Y, Zheng Y (2016). "Overview: the role of Propionibacterium acnes in nonpyogenic intervertebral discs". Int Orthop (Review). 40 (6): 1291–8. doi:10.1007/s00264-016-3115-5. PMID   26820744. S2CID   889041.
  26. ↑ Giuffre BA, Black AC, Jeanmonod R. Anatomy, Sciatic Nerve. [Updated 2023 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482431/
  27. ↑ Davis D, Maini K, Vasudevan A. Sciatica. [Updated 2022 May 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/
  28. ↑ Siddiq MAB, Clegg D, Hasan SA, Rasker JJ (October 2020). "Extra-spinal sciatica and sciatica mimics: a scoping review". Korean J Pain. 33 (4): 305–317. doi:10.3344/kjp.2020.33.4.305. PMC   7532296 . PMID   32989195.
  29. 1 2 Parks, Edward (2017). Practical Office Orthopedics. [New York, N.Y.]: McGraw-Hill. pp. Chapter 6: Low Back Pain. ISBN   9781259642876. OCLC   986993775.
  30. ↑ Halpern, Casey H. (2015). Schwartz's Principles of Surgery. Grady, M. Sean (Tenth ed.). [New York]: McGraw-Hill. pp. Chapter 42: Neurosurgery. ISBN   9780071800921. OCLC   892490454.
  31. ↑ LeBlond, Richard F. (2015). DeGowin's Diagnostic Examination. Brown, Donald D., Suneja, Manish, Szot, Joseph F. (Tenth ed.). New York. pp. Chapter 13: The Spine, Pelvis, and Extremities. ISBN   9780071814478. OCLC   876336892.{{cite book}}: CS1 maint: location missing publisher (link)
  32. ↑ Martin HD, Khoury AN, Schroder R, Gomez-Hoyos J, Yeramaneni S, Reddy M, James Palmer I (July 2017). "The effects of hip abduction on sciatic nerve biomechanics during terminal hip flexion". J Hip Preserv Surg. 4 (2): 178–186. doi:10.1093/jhps/hnx008. PMC   5467418 . PMID   28630740.
  33. ↑ Alshami AM, Alshammari TK, AlMuhaish MI, Hegazi TM, Tamal M, Abdulla FA (June 2022). "Sciatic nerve excursion during neural mobilization with ankle movement using dynamic ultrasound imaging: a cross-sectional study". J Ultrasound. 25 (2): 241–249. doi:10.1007/s40477-021-00595-7. PMC   9148322 . PMID   34036554.
  34. ↑ Crosio A, Ronchi G, Fornasari BE, Odella S, Raimondo S, Tos P (April 2021). "Experimental Methods to Simulate and Evaluate Postsurgical Peripheral Nerve Scarring". J Clin Med. 10 (8): 1613. doi: 10.3390/jcm10081613 . PMC   8070420 . PMID   33920209.
  35. ↑ Davis D, Maini K, Vasudevan A. Sciatica. [Updated 2022 May 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/
  36. ↑ ROBINSON DR (March 1947). "Pyriformis syndrome in relation to sciatic pain". Am J Surg. 73 (3): 355–8. doi:10.1016/0002-9610(47)90345-0. PMID   20289074.
  37. ↑ Martin HD, Shears SA, Johnson JC, Smathers AM, Palmer IJ (February 2011). "The endoscopic treatment of sciatic nerve entrapment/deep gluteal syndrome". Arthroscopy. 27 (2): 172–81. doi: 10.1016/j.arthro.2010.07.008 . PMID   21071168.
  38. ↑ Park MS, Yoon SJ, Jung SY, Kim SH (May 2016). "Clinical results of endoscopic sciatic nerve decompression for deep gluteal syndrome: mean 2-year follow-up". BMC Musculoskelet Disord. 17: 218. doi: 10.1186/s12891-016-1062-3 . PMC   4875686 . PMID   27206482.
  39. ↑ Speed C (May 2004). "Low back pain". BMJ. 328 (7448): 1119–21. doi:10.1136/bmj.328.7448.1119. PMC   406328 . PMID   15130982.
  40. ↑ Gregory DS, Seto CK, Wortley GC, Shugart CM (October 2008). "Acute lumbar disk pain: navigating evaluation and treatment choices". Am Fam Physician. 78 (7): 835–42. PMID   18841731.
  41. ↑ Dworkin RH, Johnson RW, Breuer J, et al. (2007). "Recommendations for the management of herpes zoster". Clin. Infect. Dis. 44 (Suppl 1): S1–26. doi: 10.1086/510206 . PMID   17143845. S2CID   10894629.
  42. ↑ Shapiro ED (May 2014). "Clinical practice. Lyme disease" (PDF). The New England Journal of Medicine. 370 (18): 1724–1731. doi:10.1056/NEJMcp1314325. PMC   4487875 . PMID   24785207. Archived from the original (PDF) on 19 October 2016.
  43. ↑ "Lyme Disease Data and surveillance". Lyme Disease. Centers for Disease Control and Prevention. 2019-02-05. Retrieved April 12, 2019.
  44. ↑ "Lyme Disease risk areas map". Risk of Lyme disease to Canadians. Government of Canada. 2015-01-27. Retrieved May 8, 2019.
  45. ↑ Ogrinc K, Lusa L, Lotrič-Furlan S, Bogovič P, Stupica D, Cerar T, Ružić-Sabljić E, Strle F (Aug 2016). "Course and outcome of early European Lyme neuroborreliosis (Bannwarth syndrome): clinical and laboratory findings". Clinical Infectious Diseases. 63 (3): 346–53. doi: 10.1093/cid/ciw299 . PMID   27161773.
  46. 1 2 3 4 5 6 Lewis RA, Williams NH, Sutton AJ, Burton K, Din NU, Matar HE, Hendry M, Phillips CJ, Nafees S, Fitzsimmons D, Rickard I, Wilkinson C (June 2015). "Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses" (PDF). Spine J. 15 (6): 1461–77. doi:10.1016/j.spinee.2013.08.049. PMID   24412033.
  47. ↑ Casey E (February 2011). "Natural history of radiculopathy". Phys Med Rehabil Clin N Am. 22 (1): 1–5. doi:10.1016/j.pmr.2010.10.001. PMID   21292142.
  48. 1 2 Ostelo RW (2020). "Physiotherapy management of sciatica". Journal of Physiotherapy . 66 (2): 83–88. doi: 10.1016/j.jphys.2020.03.005 . PMID   32291226.
  49. ↑ Fernandez M, Hartvigsen J, Ferreira PH (2015). "Advice to Stay Active or Structured Exercise in the Management of Sciatica: A Systematic Review and Meta-analysis". Spine (journal) . 40 (10): 1457–1466. doi:10.1097/BRS.0000000000001036. PMID   26165218.
  50. ↑ Basson, Annalie; Olivier, Benita; Ellis, Richard; Coppieters, Michel; Stewart, Aimee; Mudzi, Witness (2017-08-31). "The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Meta-analysis". Journal of Orthopaedic & Sports Physical Therapy. 47 (9): 593–615. doi:10.2519/jospt.2017.7117. hdl: 1871.1/c965ed2a-c397-403f-8790-275a4cb9fbde . PMID   28704626. S2CID   3421251. The majority of studies had a high risk of bias
  51. 1 2 3 Pinto RZ, Maher CG, Ferreira ML, Ferreira PH, Hancock M, Oliveira VC, et al. (February 2012). "Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis". BMJ. 344: e497. doi:10.1136/bmj.e497. PMC   3278391 . PMID   22331277.
  52. ↑ Machado GC, Maher CG, Ferreira PH, Day RO, Pinheiro MB, Ferreira ML (July 2017). "Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis". Ann. Rheum. Dis. 76 (7): 1269–1278. doi:10.1136/annrheumdis-2016-210597. PMID   28153830. S2CID   22850331.
  53. ↑ Rasmussen-Barr E, Held U, Grooten WJ, Roelofs PD, Koes BW, van Tulder MW, Wertli MM (October 2016). "Non-steroidal anti-inflammatory drugs for sciatica". Cochrane Database Syst Rev. 10 (2): CD012382. doi:10.1002/14651858.CD012382. PMC   6461200 . PMID   27743405.
  54. ↑ Waseem Z, Boulias C, Gordon A, Ismail F, Sheean G, Furlan AD (January 2011). "Botulinum toxin injections for low-back pain and sciatica". Cochrane Database Syst Rev (1): CD008257. doi:10.1002/14651858.CD008257.pub2. PMID   21249702.
  55. ↑ Balagué F, Piguet V, Dudler J (2012). "Steroids for LBP - from rationale to inconvenient truth". Swiss Med Wkly. 142: w13566. doi: 10.4414/smw.2012.13566 . PMID   22495738.
  56. ↑ Chou R, Hashimoto R, Friedly J, Fu R, Bougatsos C, Dana T, Sullivan SD, Jarvik J (September 2015). "Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis". Ann. Intern. Med. 163 (5): 373–81. doi:10.7326/M15-0934. PMID   26302454. S2CID   25696028.
  57. 1 2 Fernandez M, Ferreira ML, Refshauge KM, Hartvigsen J, Silva IR, Maher CG, Koes BW, Ferreira PH (November 2016). "Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis". Eur Spine J. 25 (11): 3495–3512. doi:10.1007/s00586-015-4148-y. PMID   26210309. S2CID   4450957.
  58. ↑ Metikala S, Sharma V (March 2022). "Endoscopic Sciatic Neurolysis for Deep Gluteal Syndrome: A Systematic Review". Cureus. 14 (3): e23153. doi: 10.7759/cureus.23153 . PMC   9010003 . PMID   35444897.
  59. ↑ Kay J, de Sa D, Morrison L, Fejtek E, Simunovic N, Martin HD, Ayeni OR (December 2017). "Surgical Management of Deep Gluteal Syndrome Causing Sciatic Nerve Entrapment: A Systematic Review". Arthroscopy. 33 (12): 2263–2278.e1. doi:10.1016/j.arthro.2017.06.041. PMID   28866346.
  60. ↑ Lemos N, Sermer C, Fernandes G, Morgado-Ribeiro A, Rossos A, Zhao ZY, Girão MJ, Peng P (May 2021). "Laparoscopic approach to refractory extraspinal sciatica and pudendal pain caused by intrapelvic nerve entrapment". Sci Rep. 11 (1): 10820. Bibcode:2021NatSR..1110820L. doi:10.1038/s41598-021-90319-y. PMC   8144185 . PMID   34031480.
  61. 1 2 Leininger B, Bronfort G, Evans R, Reiter T (February 2011). "Spinal manipulation or mobilization for radiculopathy: a systematic review". Physical Medicine and Rehabilitation Clinics of North America. 22 (1): 105–25. doi:10.1016/j.pmr.2010.11.002. PMID   21292148.
  62. ↑ Tamburrelli FC, Genitiempo M, Logroscino CA (May 2011). "Cauda equina syndrome and spine manipulation: case report and review of the literature". Eur Spine J. 20 (Suppl 1): S128–31. doi:10.1007/s00586-011-1745-2. PMC   3087049 . PMID   21404036.
  63. ↑ WHO guidelines on basic training and safety in chiropractic. "2.1 Absolute contraindications to spinal manipulative therapy", p. 21. Archived 2008-02-27 at the Wayback Machine WHO
  64. 1 2 Wilkinson, C.; Chakraverty, R.; Rickard, I.; Hendry, M.; Nafees, S.; Burton, K.; Sutton, A.; Jones, M.; Phillips, C. (November 2011). Background. NIHR Journals Library.
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