Lumbago-Sciatica Syndrome
Introduction
Lumbago It refers to Low Back Pain (LBP)
If the pain includes numbness in the
buttocks, back or leg, along with a
tingling feeling that radiates down
Sciatica the leg to the foot, it is known as
sciatica (Sciatic nerve compression)
Lumbago - Causes
• Overuse of the lower back and the sudden lifting of a heavy load
• Excessive bending or other repetitive motions involving the lower back
• Osteoarthritis
• Spinal arthritis (Spondylosis)
• Slipped or herniated disc
• Osteoporosis
• Spinal stenosis or compression of the spinal nerves
• Scoliosis
• Malignant/benign spinal tumors
Symptoms
• Pain located in the lumbar area of the spine
• Lower back stiffness
• Muscle tension and achiness
• Deranged mobility
• Restricted movement of the spine (bend over or lean backwards)
• Pain felt in the lower portion of the back that can spread out into the
buttock, the groin or to the back of the thigh
• Swelling or inflammation of the back or leg can be a warning sign
• Lower back pain when you sneeze or cough can also suggest lumbago
Sciatica - Introduction
• Sciatica occurs when one or more nerve roots from L4 to S3 are irritated
or compressed due to conditions such as a herniated disc, stenosis or
degeneration
• Radicular pain from the sciatic nerve root is typically felt in the thigh, calf
and/or foot
• Sciatica is one among the type of radiculopathy
• Radiculopathy, also commonly referred to as pinched nerve, refers to a
set of conditions in which one or more nerves are affected and do not
work properly (a neuropathy)
• This can result in pain (radicular pain), weakness, numbness or difficulty
controlling specific muscles
Causes
• Rarely, sciatica may develop due to tumors, infection, formation of scar tissue,
collection of fluid, Pott’s disease (spinal tuberculosis) or fracture in the lumbar
spine
• While rare, sciatica may also develop as a complication of incorrect muscular
injection methods in the buttock or following a hip joint replacement surgery
• Approximately 1% of pregnant women may develop sciatica at some point
during pregnancy
Signs & Symptoms
• Lower back pain
• The pain extends from the lower back all the way through the back of the
thigh and down through the leg
• Depending on where the sciatic nerve is affected, the pain may also extend
to the foot or toes
• Pain in the rear or leg that is worse when sitting
• Hip pain
• Burning or tingling down the leg
• Weakness, numbness or difficulty moving the leg or foot
• A constant pain on one side of the rear
• A shooting pain that makes it difficult to stand up
• Sciatica usually affects only one side of the lower body
Pathology
Sciatica is generally caused by the Intervertebral spinal discs consist of
compression of lumbar nerves L4 an outer anulus fibrosus and an
or L5 or sacral nerve S1 inner nucleus pulposus
Discs separate the spinal
vertebrae, thereby increasing The anulus fibrosus forms a rigid ring around
spinal stability and allowing nerve the nucleus pulposus early in human
roots to properly exit through the development, and the gelatinous contents of
spaces between the vertebrae the nucleus pulposus are thus contained
from the spinal cord within the disc
When there is a tear in the anulus fibrosus,
As an individual ages,
the nucleus pulposus may extrude through the
the anulus fibrosus weakens
tear and press against spinal nerves within the
and becomes less rigid,
spinal cord, cauda equine or exiting nerve
making it at greater risk for
roots, causing inflammation, numbness or
tear
excruciating pain
Inflammation of spinal tissue can then spread
to adjacent facet joints and cause facet
syndrome, which is characterized by lower back
pain and referred pain in the posterior thigh
• Less commonly, sacral nerves S2 or S3 or compression of the sciatic
nerve itself may cause sciatica
• In 90% of sciatica cases, this can occur as a result of a spinal disc bulge
or herniation
• Other causes of sciatica secondary to spinal nerve entrapment include the
roughening, enlarging or misalignment (spondylolisthesis) of vertebrae
or disc degeneration
• When sciatica is caused by compression of a dorsal nerve root, it is
considered a lumbar radiculopathy or radiculitis when accompanied by an
inflammatory response
Risk factors
• Age: Age-related changes in the spine, such as herniated disks and
bone spurs
• Obesity: By increasing the stress on spine, excess body weight can
contribute to the spinal changes
• Occupation: Carry heavy loads/drive a motor vehicle for long
periods
• Prolonged sitting: People who sit for prolonged periods or have a
sedentary lifestyle
• Diabetes: Increases your risk of nerve damage
Diagnosis
• Examination tests;
• SLR test
• Bowstring test
• Flip test
• Lumbo-sacral X-ray
• Lumbo-sacral MRI
• Lumbo-sacral CT
• EMG
Differential diagnosis
• Lumbar Spondylolisthesis
• Ankylosing spondylitis
• Lumbar spondylosis
• Sciatica syndrome
Complications
• Partial/complete loss of leg movement
• Partial/complete loss of sensation of leg
• Loss of control over bowel/bladder function
• Nerve damage
• Spinal stenosis
• Facets syndrome
Conclusion
• Lumbago and Sciatica
• Severe condition without treatment may cause permanent
Radiculopathy/Neuropathy
• Treatment at early stage is effective but age, body weight, presence
of other metabolic disorders worsening the situation
• Disc herniation, bony spurs are other foremost predisposing factors
