Sciatica is a common radiating pain syndrome caused by irritation of the sciatic nerve root, usually from a herniated disc at L4-L5 or L5-S1. It presents as low back pain radiating down the back of the leg and can affect the foot. Sciatica is a symptom rather than a diagnosis. Examination may reveal a positive straight leg raise test. Differential diagnoses include spondyloarthropathies. Imaging like MRI can identify disc herniations while conservative treatments include rest, analgesics, and epidural injections. Surgery is considered if conservative options fail or neurological deficits are present.

1. SCIATICA

2.  Most frequent radicular pain syndrome of spinal
origin.
 Occurs due to irritation of a spinal nerve root
associated with disc herniation at L4-L5 OR L5-S1.
 Pain usually begins in the lower back radiating to the
sacroiliac regions, buttocks,thighs,calf & foot.
 Sciatica is a symptom , NOT A DIAGNOSIS.

4. ONSET
 Onset is often traumatic.
 Exertion or a forced movement results in acute low
back pain, followed by referral to the leg.
 Exacerbated by standing, sitting, exertion, coughing
and sneezing.
 Relieved by lying down.

5. TOPOGRAPHY
 It’s referral pattern follows that of L5 or S1 territory:
 L5:buttock, anterior aspect of thigh, lateral
malleolus, dorsum of foot, great toe or the medial 3
toes.
 S1:buttock,posterior aspect of thigh, knee,leg & heel,
to the sole or lateral side of the foot upto the fifth toe.
 In the distal limb, pain may be replaced by tingling
or numbness.

6. TOPOGRAPHY

7. CAUSES
 INFLAMMATORY
 NERVE ROOT COMPRESSION

8. CAUSES
INFLAMMATORY
Sciatic neuritis
arachnoiditis

9. CAUSES
 NERVE ROOT COMPRESSION
 Compression in the vertrebral canal by disc, tumour,
TB.
 Compression in the intervertebral foramen due to
root canal stenosis because of osteoarthritis ,
spondylolisthesis , facet arthropathy , tumours.
 Compression in the buttock or pelvis by
abscess,tumours,hematoma.

10. CAUSES
 PIRIFORMIS SYNDROME
Neuromuscular syndrome that occurs when the
sciatic nerve is compressed/irritated by the
piriformis muscle causing pain, tingling &
numbness in the buttocks & along the path of sciatic
nerve.
Wallet sciatica/fat wallet syndrome
Caused/aggravated by sitting with a large wallet in
the affected side’s rear pocket.

12. CAUSES

13. CLINICAL EXAMINATION
 STRAIGHT LEG RAISING TEST IS POSITIVE.
Patient in supine position
Examiner lifts the leg gradually with the knee kept
straight.
Between 30 and 70 degree nerve comes into contact
with the prolapsed disc & the patient complaints of
pain.

14. CLINICAL EXAMINATION
 LASEGUE’S SIGN: MODIFICATION OF SLRT.
HIP IS FLEXED & THE KNEE IS ALSO FLEXED AT
90 DEGREES
THE KNEE IS THEN GRADUALLY EXTENDED BY
THE EXAMINER.
IF NERVE STRETCTH IS PRESENT: PATIENT
WILL EXPERIENCE PAIN IN THE BACK OF
THIGH OR LEG.

15. SIGNS IN LUMBAR ROOT COMPRESSION
DISC LEVEL ROOT SENSORY
LOSS
WEAKNESS REFLEX
LOSS
L3/L4 L4 INNER CALF INVERSION
OF FOOT
KNEE
L4/L5 L5 OUTER CALF
& DORSUM
OF FOOT
DORSIFLEXI
ON OF TOES
L5/S1 S1 SOLE &
LATERAL
FOOT
PLANTAR
FLEXION
ANKLE

16. CLINICAL FORMS OF SCIATICA
 HYPERALGIC SCIATICA
 PARALYTIC SCIATICA

17. HYPERALGIC SCIATICA
 Characterized by severe pain
 Patient prefers to remain in bed & is hesitant even to
move slightly.
 Specific form : myalgic sciatica

18. Myalgic sciatica
Seen most commonly in disc heerniations affecting
S1 nerve root.
Neuralgic pain is associated with intense & often
continous muscular pains and cramps affecting the
biceps femoris, triceps surae & ocasionally the
gluteal muscles.
Mild motor deficit.
Fasciculations +

19. PARALYTIC SCIATICA
 Slight motor deficit can be detected.
 More frequent in L5 sciatica
 Most often paralytic L5 sciatica leads to foot drop,
which forces the patient to modify the gait pattern.

20. DIFFERENTIAL DIAGNOSIS
 SPONDYLOARTHROPATHY
Usually seen in the young.
Pain does not refer distal to the knee.
Bilateral or alternating occuring episodically.
Not modified by activity.
Nocturnal pain is common.
Diagnosis: PA Views of pelvis or specialized hibbs
view of the sacro illiac joints.
ESR is elevated.
Rapid respone to medication.

21. DIFFERENTIAL DIAGNOSIS
 INTRAMEDULLARY TUMOURS(GLIOMAS)
Nocturnal pain is common
Patient will stand or walk to bring relief.
Physical activity has no influence on the pain.
Spine is sometimes very stiff.
Radiograhic studies are normal
Diagnosis : ct/myelography
Surgery relieves the patient

22. Differential diagnosis
 Metastatic leisons or a multiple myeloma can result
in intense refractory sciatic pain.
 Infectious discitis
 Infectious sacro illitis

23. PSUEDOSCIATIC SYNDROMES
 Some disorders can simulate sciatic pain.
 Periarthritis of the hip

24. IMAGING
 RADIOGRAPHY
Most occasions radiographs is normal
Loss of lumbar lordiosis
Scoliosis
Reduced intervertebral disc spsce.

25. IMAGING
 CT
Morphologic abnormalities in relation to a
herniated disc.
Relative impact on adjacent soft tissues
Any neuroforaminal or extra foraminal
encroachment.

26. IMAGING
 MYELOGRAPHY
Excellent for assesing the entire sub arachnoid space.
Assesment of spinal stenosis
Disadvantages: headache’s, nausea

27. IMAGING
 DISCOGRAPHY
Often neglected modality
Excellent means of assesing disc pathology

28. Magnetic resonance imaging
 STUDY OF CHOICE for recurrence following
disectomy, to differentiate recurrent herniation from
peri neural fibrosis.
 Detect other leisons.

29. TREATMENT
CONSERVATIVE MANAGEMENT
 Intermittent bed rest with movement for short
periods in between.
 Patient should lie on a firm mattress, in the position
that feels most comfortable.
 Rigid lumbar orthosis can shorten the duration or
obviate the need for bed rest.
 Heat/cold application

30. TREATMENT
ANALGESICS & ANTI INFLAMMATORY DRUGS
In hyperalgic forms, intrathecal injection of steroids
by LUCHERINI’S technique can produce a
remarkable reduction in pain
Epidural analgesia in severe cases.

31. TREATMENT
 SURGERY
When neurological deficit is present
Failure of conservative management
Chemonucleoloysis
Percutaneous disectomy

32. REHABILITATION
 THERAPEUTIC EXERCISES

33. THANK YOU