Sciatica
Definition
Pain radiating from back to buttock to back of thigh to calf is sciatica
Pain in sciatic neeve region / dermatome is sciatica
Leg pain from buttock to calf
Causes
Multiple causes can create sciatica
SPINAL CAUSES ( Common )
Slip Disc / herniated disc / disc bulge one of commonest commonest cause -pain and paresthesiae in dermatomal pattern
Nerve compression due to Degenerative facet arthritis /canal stenosis or some progressive disease like infection / TB / Tumor can present as sciatica. – In disease related sciatica the pain is not activity related and is usually present even at rest.
EXTRASPINAL CAUSES (Not uncommon)
Sacroillitis – one of the common causes usually missed in diagnosis
Hip pathologies – AVN, hip OA
Peripheral neuropathy
Visceral and vascular insufficiency
Reffered pain
Most of these may mimic like sciatica as pain is in same location but cause is extraspinal.
THUMB RULE For Management
Always examine and take detailed history to rule out exact cause and differentiate spinal vs extraspinal cause of sciatica
History taking and clinical examination is the best mode to establish near confirmed diagnosis
Conservative treatment with medication and physiotherapy under supervision – usually helps in degenrative pathology with no neurology deficit
Surgery may be required in small subset of patients progressive symptoms with neurology
MICROENDOSCOPIC SURGERY – MINIMAL INVASIVE SPINE SURGERY – is extremely safe simple and predictive with promising results and least bed rest/ hospital stay
