Sciatic nerve inflammation

Sciatica called any pain caused by irritation or compression of the sciatic nerve.

The sciatic nerve is the longest nerve in our body. It passes through the hips, buttocks and legs, ending in the feet. If something puts pressure on the sciatic nerve or irritates it, it can lead to pain starting in the lower back and going down the leg to the calf. Pain in sciatica (ischialgia) can range from mild to intense.

Intervertebral hernia (outdated – intervertebral hernia) of the lumbar spine is the most common cause of sciatica. Intervertebral hernia is a material of the jelly-like pulposal nucleus of an intervertebral disk that has leaked through a crack or tear in the fibrous ring, the outer layer of the disk. Once in the spinal canal, the disk material (pulpal nucleus) squeezes the nerve roots of the spinal cord, causing chemical and mechanical irritation, causing the nerve to be impaired, which causes the onset of pain symptoms.

Other common causes of sciatica include:

  • degenerative changes in the intervertebral discs (osteochondrosis),
  • spondylolisthesis,
  • spinal canal stenosis in the lumbar spine,
  • piriformis syndrome,
  • dysfunction of the sacroiliac joint.

Although intervertebral disc degeneration is a natural process resulting from aging, for some people one or more intervertebral discs in the lumbar spine affected by degenerative changes can cause irritation of the nerve roots and cause sciatica.

Spondylolisthesis appears when, as a result of a small fracture of the part of the bone connecting the two joints of the vertebra, caused by pressure on the bone, the body of one vertebra slides forward from the body of the other vertebra. Collapse of the intervertebral disc space, fracture and slippage of the intervertebral disk can lead to pinching of the nerve and cause sciatica.

Sciatic nerve inflammation

Spinal stenosis may be congenital or occur in the process of aging of the body and is quite common among patients over 60 years old. Stenosis is often combined with one or more of the following conditions: spondyloarthrosis, intervertebral hernia, leading to compression of the nerve roots, which causes sciatica.

Irritation of the sciatic nerve may be caused by the so-called piriformis syndrome. The pear-shaped muscle is located in the buttock; it can irritate or pinch the nerve root, leading to sciatica-like pain. However, the existence of the pear-shaped muscle syndrome is controversial, most often the pain in the buttock is associated with the pinching of the sciatic nerve in the intervertebral hernia.

Pathology of the sacroiliac joint, being at the very bottom of the spine can also cause irritation of the L5 nerve, leading to the appearance of sciatica-like pain. Leg pain in this condition may be similar to sciatica.

In addition to the most common causes, sciatica can cause a variety of conditions, such as:

  • pregnancy. Changes in the body during pregnancy, including weight gain, a shift in the center of gravity, and hormonal changes can lead to sciatica.
  • scar tissue. If the scar tissue squeezes the nerve root, it can cause sciatica.
  • muscle strain. In some cases, the inflammation caused by the stretching of the muscle can put pressure on the nerve root, thus causing the sciatic nerve along.
  • spinal cord tumor. In rare cases, such as cancer, the tumor can squeeze the nerve root and cause sciatica symptoms.
  • infection (very rare). Infection in the lumbar spine can affect the nerve root and thus cause sciatica symptoms.

The main risk factors for sciatica include:

  • aging. Age-related changes of the spine, such as intervertebral hernia and spondylosis,
  • obesity. By increasing the load on the spine,
  • work and hobby. Activities that include torso twisting, carrying heavy loads, or driving a long time,
  • long sitting People who, due to certain circumstances, are forced to sit for a long time or lead a sedentary lifestyle,
  • diabetes. This disease due to an increase in blood glucose increases the risk of nerve damage,

For some people, sciatica pain can be severe and can lead to disability. In other cases, symptoms may occur rarely and cause only minor inconveniences, but have the potential to worsen.

One side of the body is usually affected, and the pain usually begins in the lower back, goes through the back of the thigh and goes down the leg.

Symptoms of sciatica

The most common combinations are the following:

  • back pain (if it is present at all) is not as pronounced as pain in the lower limbs,
  • constant pain in only one buttock and leg, rarely on the left and right sides,
  • pain in the lower back or in the buttock and descending along the path of the sciatic nerve: down the back of the thigh down to the foot,
  • pain subsiding in a lying position or when walking, but aggravated in standing or sitting positions,
  • pain, which is usually described as sharp and acute,
  • numbness and weakness, tingling sensation in the legs,
  • weakness or numbness when moving with your foot or foot,
  • sharp or shooting pain in one leg, which makes standing and walking difficult,
  • depending on the location of the sciatic nerve lesion, symptoms may include pain in the feet and toes,

There are two nerve roots leaving the lumbar spine (L4 and L5) and three nerve roots leaving the sacral spine (S1, S2 and S3). These five nerves form the sciatic nerve, and then again move away from each other in the leg to transfer motor and sensory functions to different parts of the leg and foot.

Symptoms of sciatica vary depending on the location of the trapped nerve. Here are some examples:

  • when pinching the L4 nerve root, symptoms usually affect the hip. Patients may feel weak when straightening their legs and may have a weakened knee jerk.
  • if you pinch the L5 nerve root, pain can affect the ankle and the big toe. Patients may feel pain or numbness in the forefoot, especially on the skin area (membrane) between the big and second toes.
  • if the nerve root S1 is pinched, the symptoms affect the outer part of the foot, and the pain may radiate to the small toe. Patients may feel weak when lifting their heels off the ground or trying to stand on tiptoes. The knee jerk may also be reduced.

Since several nerve roots can be compressed, patients may experience a combination of the above symptoms.

In rare cases, the symptoms quickly worsen and may require immediate surgical intervention. These symptoms include:

  • symptoms that continue to worsen may indicate a possible nerve destruction, especially if the progressive symptoms are of a neurological nature (for example, weakness).
  • symptoms affecting both legs and causing impaired control or dysfunction of the intestine or bladder, which may indicate a horse tail syndrome. Horsetail syndrome is a severe compression of one or more nerve roots and is relatively rare (approximately 2% of all intervertebral hernias in the lumbar spine).

Sciatic nerve inflammation

Patients should urgently seek medical attention if they have any of the above symptoms.

Diagnosis of sciatica begins with a trip to the neurologist. During the medical examination, the doctor can check the patient’s muscle strength and reflexes. For example, he may ask the patient to look like heels or toes, stand from a squatting position and, while lying down, simultaneously raise both legs at an angle of 90 degrees to the body. The pain caused by sciatica from such actions is usually exacerbated.

The doctor also asks the patient questions regarding his medical history and life circumstances. Thus, he is looking for warning signs that may indicate that sciatica is caused by a serious medical condition, such as horsetail syndrome, infection, or cancer.

In ponytail syndrome, the following symptoms are observed:

  • numbness in the lower back, buttock and leg,
  • loss of urination and defecation,
  • feeling of weakness in the leg and foot,

Diagnosis of sciatica

  • blood test to detect infection
  • X-rays can only reveal the effects of spondylosis, therefore it is better not to start examinations with X-rays,
  • magnetic resonance imaging (MRI). This procedure uses a powerful magnet and radio waves to create images of the spine in cross section. MRI creates detailed images of bones and soft tissues, such as intervertebral discs,
  • computed tomography (CT). A contrast agent may be introduced into the spinal canal prior to CT. Such a study will be called CT myelography. The dye will circulate around the spinal cord and nerve roots, which in the picture will look white. The study is conducted in case of contraindications for MRI.

It should be remembered that the most common cause of sciatica is intervertebral hernia of the lumbar spine. Therefore, the first step is to perform an MRI scan of the lumbar spine and make an appointment with a doctor.

Consultations have been held free of charge for 22 years in our Clinics.

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