Sciatica: Causes; Symptoms; and Prophylaxis
Radiculitis or radiculopathy is a complex of specific symptoms associated with the withdrawal of nerve roots from the spinal cord. The pathological process can be found in any part of the vertebral column, but most often it is located in the lumbar-sacral region. This area is subject to maximum stress from the vertical position of the body and is particularly prone to osteochondrosis and related diseases.
General information on sciatica
The vertebral column consists of separate vertebrae separated by cartilage discs. Inside the hollow channel in the spinal cord, from which the anterior and posterior nerve cores are removed on each side. The first is responsible for the motor functions, and the second is for the sensitivity. They pass through special channels between the vertebrae and merge into a single spinal nerve whose branches are responsible for a particular part of the body.
During the development of osteochondrosis, protrusion or hernias of the intervertebral disc, the formation of bone sprouts, and other volumetric processes, the root is compressed. This entails a complex of sensitive and motor disorders that form the symptoms of sciatica.
The most frequent cause of the development of radiculitis is osteochondrosis, which results in the appearance of protrusions and herniation of intervertebral discs. In addition, pathology may cause:
- Disturbances of the posture and curvature of the spine (kyphosis, scoliosis, lordship);
- Injuries to the spine;
- Malignant or benign tumors in the area of the release of nerve roots;
- Inflammatory diseases: osteoarthritis, spondylosis;
- Infections of the nervous system (meningitis, encephalitis) and bone (osteomyelitis);
- Hormonal and metabolic disorders (diabetes mellitus, acromegaly);
- congenital vertebrae disorder.
The risk factors that increase the risk of developing sciatica include:
- Hyperdynamics, especially work and/or rest in a sitting position;
- Acute or periodic hypothermia;
- Excess body mass
- Vitamin deficiency, shortage of minerals;
- Over 45 years of age;
- Frequent lifting of heavy loads;
- Professional sports (martial arts, weightlifting);
- Acute or chronic intoxication
Types of pathology
Radiculitis is classified according to the level of delivery. The following pathologies are distinguished:
- Neck and chest
- Thoracic lumbar
Some types of classification also produce retinal sciatica.
The symptoms of radiculitis are determined by its localization: in the lumbar and sacral forms, it is mainly the lower half of the body, while lesions of the cervical and thoracic roots often mimic lesions of the heart, lungs, or stomach.
The main symptom of any form of sciatica is pain. It usually comes out abruptly against the backdrop of bad head rotation, heavy lifting, hypothermia. The sensation is so strong that a person often stops moving. The movements increase the pain, which is why many patients remain in a position of need that allows a little relief.
Concomitant symptoms are:
- Numbness or, conversely, increased skin sensitivity;
- Muscle weakness in the affected region;
- Small twitches of muscle fibers;
- The tingling, the burning, the crawling goosebumps.
Most often radiculopathy is acute. The chronic variant of the disease is characterized by less pronounced symptomatic, periodic nagging pain in the problem area. Any provocative factor can easily turn a chronic process into an acute one.
The pain in the neck lesions begins in the posterior surface of the neck and the back of the head and extends to the shoulder, upper chest, and even the hand down to the fingers. The sensation is sharply increased by the movement of the head as well as the arm on the affected side. In severe cases, headaches, reduced hearing and vision, and severe dizziness are reported.
Symptoms of chest sciatica
Root lesions in the thorax are extremely rare. When given the spine, the patient experiences pronounced intercostal neuralgia: pain in the course of the ribs. The sensation is heightened by deep breathing, the rotation of the hull. Often the pain spreads to the hand. When such symptoms occur, it is important to make a full diagnosis promptly, as similar symptoms occur during myocardial infarction, spontaneous pneumothorax, and other hazardous conditions.
Symptoms of lumbosacral sciatica
Lesions of the lumbar-sacral zone are the most frequent variant of the disease. Depending on the location of the problem spine, the pain may be:
- Only in the lower back;
- In the loin and sacrum extending to the thigh and drumstick;
- in the buttock area with the back of the thigh spread.
In some cases, painful sensations are accompanied by dysfunctional pelvic organs: problems with urination, decreased sexual function, etc.
Neurologists diagnose all forms of sciatica. The patient is required to undergo a full examination to eliminate other diseases with similar symptoms:
- Interview: The physician ascertains the nature of the pain, its intensity, its localization, distribution, the circumstances of its occurrence, and its aggravation; during the collection of the history, the data on chronic diseases, injuries, hereditary factors are specified;
- General and neurological examination: temperature, pulse, blood pressure, skin sensitivity, reflex quality, maximum pain zones, etc.;
- General and biochemical blood test: helps to detect inflammation, determine blood sugar levels and other indicators;
- A general urine test, a kidney test to detect or eliminate renal pathology (particularly relevant in the lumbar-sacral reticulum);
- X-rays of the vertebrae problem area: allow to see fractures, tumors, signs of osteochondrosis;
- Computer tomography: allows the verification of the condition and thickness of intervertebral disks and the detection of bone spreads;
- MRI: replaces CT and X-rays, gives maximum information on the state not only of bones and cartilage but also of soft tissues;
- Electrocardiogram, UZI: Prescribed for thoracic and cervical osteochondrosis to eliminate cardiac pathology;
- Ultrasound of abdominal organs, FGDS to eliminate problems with the stomach, pancreas, liver, etc.;
- Brain MRI, brain and neck vascular ultrasound: prescribed for neck sciatica.
If necessary, the doctor may prescribe other examinations as well as related consultations. This makes it possible to pinpoint the cause of pain and exclude more dangerous diseases and conditions.
The treatment of all forms of sciatica, from cervical to lumbar sacral, requires a complex approach, depending on the symptoms and their severity. Doctors use several techniques:
- Drug therapy (various preparations in the form of creams, gels, tablets, and injectables);
- Non-pharmacological therapy (physiotherapy, LPC, massage, acupuncture, etc.);
- Surgical treatment (used in advanced forms of the original disease).
The medicinal treatment of sciatica is directed to maximally analgesic treatment, removal of muscle spasm, and restoration of full-fledged transfer of impulses along nerve fibers.
The following groups of drugs have an analgesic effect:
- NSAIDs (non-steroidal anti-inflammatory agents): nimesulide, diclofenac, meloxicam, ibuprofen, and their equivalents; prescribed in various forms depending on the severity of the symptoms; help to stop the inflammatory process and relieve pain;
- Analgesics: analgesics, novocaine, lidocaine, and others; applied similarly to NSAIDs, relieve pain syndrome;
- Hormonal anti-inflammatory agents (glucocorticosteroids): Hydrocortisone, dexamethasone; used in the inefficiency of previous groups; propane, long-acting injection drug, has a good effect in chronic radiculitis;
- Spasmolytics: painkiller and analogs; relieve muscle spasm, alleviating the patient’s condition;
- Antiedema agents (diuretics, sulfate magnesium); remove swelling from the stapled spine, reducing pain syndrome.
Sedatives help to increase the effect of painkillers. They stabilize the nervous system and allow a person to rest a bit.
Additional drugs are prescribed to improve nerve conductivity: vitamins of group B (milgamma, neuromultivite, and analogs). In the case of cervical sciatica, which causes headaches, nausea, dizziness, appropriate therapy is applied, plus drugs to improve microcirculation in the brain structures.
It is mandatory to prescribe local drugs for the rapid removal of pain syndrome. In addition to analgesics or NSAIDs, they may contain irritating components (menthol, turpentine, etc.). By expanding the capillaries, the main active substance is absorbed faster.
Non-pharmacological treatment is prescribed outside the acute stage of the disease. It is aimed at strengthening the muscle frame, improving microcirculation in the problem area, and activating tissue regeneration processes. Depending on the situation:
- Physiotherapy (laser and UV therapy, dirt, electro-phoretic or phonophoresis with analgesics or hormones, magnetotherapy);
- Massage (carried out by a compassionate technique in order not to cause a repetition of the nerve root);
- Therapeutic exercise to strengthen the muscle corset (special exercise complexes are used to relieve the vertebral column);
- Acupuncture therapy
- manual therapy
- Spine traction to relieve stress on the nerve spine (underwater traction).
The surgeon’s help is necessary if the damage to the nerve root cannot be corrected using conservative methods. The surgeons remove the hernia, the intravertebral disc, or artificially extend the opening through which the roots pass. In some cases, the vertebral column is stabilized by special constructions. The specific procedure of operation is selected individually.
First aid for acute sciatica
An acute bout of sciatica can cause extreme pain that inhibits the movement of a person. To relieve his condition, it is necessary:
- Place or place a person in a way that is convenient (preferably flat);
- Minimize movements
- Take painkillers and sedatives from hand-held drugs (NSAIDs, analgesics, valerian-based agents, hollows, etc.);
- Apply painkiller ointment to the problem area;
- If it is not the first attack and the patient has a special corset, put it on.
Acute sciatica requires medical attention, which is why it is necessary to call a doctor for emergency treatment and go to the clinic for an examination after the acute pain syndrome has subsided.
Sciatica complications are rare. They are usually caused by excessive stress and the involvement of neighboring structures in the pathological process. Occasionally, professionals face the following consequences:
- ischemia and heart attack of the spinal cord;
- The inflammatory process of spinal cord structures (arachnoiditis, epidural);
- Paralysis of the limb (total or partial).
Timely examination and comprehensive treatment reduce the risk of developing complications to zero.
It’s almost impossible to get rid of sciatica, or osteochondrosis that causes it. The main purpose of the treatment and prophylactic measures is to reduce the frequency and intensity of attacks and to allow the person to feel as free as possible.
Effective prevention of radiculopathy requires:
- Eliminate hyponymy: daily light physical activity is recommended, without undue influence on the spine (walking, cycling, swimming); the main thing is not to strive for records, since professional sports, unlike amateur sports, often cause injuries;
- Avoid raising weights, both in professional activities and in sports or hobbies;
- Exercise posture and avoid stomping or distortion of the spinal column; this applies both to walking and to working at a computer or desk;
- Regularly perform a prophylactic set of exercises to strengthen the muscles of the back;
- sleep on a rigid, orthopedic mattress and a quality pillow;
- To eat properly, avoid overeating and consume sufficient vitamins and micronutrients;
- Normalize body mass in excess;
- Minimize stress, sleep, fatigue;
- Avoid hypothermia
- Timely comprehensive screening and elimination of all chronic diseases.
Compliance with doctors’ recommendations will significantly reduce the risk of another attack and lead a full life.