Sciatica

Sciatica.
2011
by Fahad Alhulaibi
KFU

1. SciaticaSciatica
Presented By:
Fahad H. Al Hulaibi
King Faisal University
2011

2. Definition
•Sciatica is pain in the
lower extremity resulting
from irritation of the
sciatic nerve. The pain of
sciatica is typically felt
from the low back
(lumbar area) to behind
the thigh and radiating
down below the knee &
may reach the foot .

3. Etiology
1)Disc herniation :
may occur in different levels
of lumbosacral vertebrae ,
but the most common are
L5 or S1 .

Risk Factors

4. 2) Spinal stenosis:
is a narrowing within the
vertebrae of the spinal
column that results in
too much pressure on
the spinal cord . The
most common causes of
spinal stenosis are
related to the aging
process in the spine

5. 3) Spondylolisthesis :
degenerative cause of spinal
stenosis which is anterior
or posterior displacement
of vertebra .

6. •4) other causes :
include irritation of the nerve from adjacent
bone, tumors, muscle, internal bleeding,
infections, injury, and other causes. Sometimes
sciatica can occur because of irritation of the
sciatic nerve during pregnancy.

7. Clinical pictures
1- pain:
The most common
symptom from sciatica.
Most people describe a
deep, severe pain that starts
low on one side of the back
and then shoots down the
buttock and the leg with
certain movements.

8. •In most people, the pain is made worse by
sneezing, coughing, laughing, or a hard bowel
movement. Bending backward can also make
the pain worse.
•You may also notice a weakness of the leg or
foot, along with the pain. The weakness may
become so bad patient can't move his foot.

9. 2- Numbness.
3. Walking difficulty.

10. Examination
•The physical
examination of sciatic
patients should include:
observation, palpation,
determination of the
range of motion of the
spine, a root tension test
and evaluation of the
neurological status of the
lower limbs .

11. •straight leg raising test “Lasègue sign“ :
stretches the L5 and S1 roots, and this test is
regarded positive if leg pain is aggravated
when the affected leg.

12. •testing of dorsiflexion strength of the ankle and
the big toe, with weakness suggesting:
mainly L5 dysfunction.
•testing of ankle reflexes to evaluate :
S1 root dysfunction .
•testing of light touch sensation in the medial
(L4), dorsal (L5) and lateral (S1) aspects of the
toe .

14. Investigation
•The most helpful
investigation is MRI.
•Also we can use CT
scan .
•X ray to see losing of
normal lardosis.

15. Treatment
1- medical: if there is no Neuro defect.
•Sciatica Pain Relief
Pain is best treated with a non-steroidal anti-
inflammatory drugs (NSAID) such as ibuprofen or
codeine (in acute cases).
•Physiotherapy.
•Muscle relaxant.

16. 2- Surgery
Some patients with sciatica may find significant
relief from surgery. In cases of herniated discs, a
surgical procedure called a laminectomy may be
performed. In this procedure, a portion of the
posterior arch is removed to relieve pressure on
pinched nerve tissues.
•In cases of spinal stenosis, the portion of bone that
is putting pressure on the sciatic nerve system can
be removed.

17. •Cauda equina syndrome :
is a serious neurologic condition in which
there is acute loss of function of
the lumbar plexus.
Bilatral scaitica.

18. References
•Sciatica: Studies of symptoms, genetic factors, and treatment with
periradicular infiltration Chapter 2. Review of the literature .
•^ "sciatica" at Dorland's Medical Dictionary .
•Oliphant, D (2004). "Safety of Spinal Manipulation in the Treatment of
Lumbar Disk Herniations: A Systematic Review and Risk Assessment".
Journal of manipulative and physiological therapeutics .

19. Thank you