Sciatica

Sciatica is a disease of the roots of the spinal cord. There are radiculitis primary (infectious, toxic) and secondary, is most commonly associated with the pathology of spine and spinal cord. There are also leningradkoye - infectious disease roots with the spread of pathological process on the membranes of the spinal cord; occurs when the rheumatic fever, brucellosis, syphilis and manifests the multiple lesions of the roots and meningeal symptoms.
Secondary radiculitis can be caused neuromas roots, tumors of the spine, tuberculous spondylitis, osteomyelitis, osteochondrosis, traumatic spinal cord injuries. Radicular pain when neuromas are permanent, not amenable to drug therapy and combined with signs of compression of the spinal cord and the increased content of protein in the cerebrospinal fluid (see Spinal cord tumors). Women sciatica is often caused by inflammation, or tumors of the ovaries and uterus.
The most common cause of secondary radiculitis is osteochondrosis of the spine (spondylosis, spondylarthrosis), i.e., age-related degenerative changes of intervertebral discs, joints and ligaments in the spine. The process starts with dehydration disks, the pulpous nucleus which loses its elasticity and through the cracks of the fibrous ring can Vibhuti outwards, which is accompanied by the formation of hernia of intervertebral disk (see Lumbago). As degeneration of disks on the edges of the vertebral bodies grow bone thorns - osteophytes. Herniated discs and osteophytes are most likely to arise in the lumbar and the cervical parts of the spine, mainly between the fourth and fifth lumbar, V lumbar and I sacral and between V-VI and VII cervical vertebrae. Discogenic radiculitis develop in individuals engaged in hard physical labor, or untrained people with congenital weakness of articular-ligamentous apparatus of the spine.
The clinical picture of primary and secondary radiculitis has a number of similar features, but secondary radiculitis occur more frequently.
Downstream there are acute and chronic radiculitis, the latter often are of a recurrent nature. Sciatica is manifested by local pain along one or several closely located to the rear of the nerve roots. Along with the pain observed sensitivity disorders, rare musculoskeletal disorders. For sciatica distinguish two stages: lumbaginous and radicular.
Lumbodynia - dull aching or pain in the lumbar region that occur after prolonged physical work, especially in the uncomfortable position of the body and in the cold, either with an awkward movement. Lumbalgia stage is the reflex or mechanical irritation of nerve endings in the ligaments of the spine. To reduce pain patient takes forced a fixed position with a slope of the body forward or to the side, avoiding even the slightest movements of the spine, especially in the lumbar spine. On examination, the patient in nizhnegorodski and lumbar region is defined by a sharp voltage long muscles of the back, feeling them painful, especially at the patient's side. Duration of this stage may vary from a few days to several weeks, after which the pain subside.
If the disease progresses and becomes radicular stage, pain spreading from the lumbar region in the buttocks, the back-the outer surface of the femur and tibia and can "give" in the heel or the thumb. Pains are unilateral and bilateral. Discogenic radicular pain often appear after cooling, colds that cause swelling of the spine and pinched it in Suzanna disc herniation or osteophytes intervertebral foramen. Radicular pains are blunt and sharp, accompanied by a burning sensation, "crawling", "passing an electric current in the field innervated by the struck nerve root. Pain worsens when walking, sitting, in a vertical position, reduced when lying down. In bed, the patient usually takes distress on his side or on his back bent and given to the stomach leg or knee-elbow position on his stomach, as in these positions are expanding intervertebral foramen, decreased tension of the roots and weakens pain. Sitting down on a chair, the patient relies only on the healthy side, and when you walk podtalkivaet injured leg, avoiding sharp movements.
During the inspection of the lumbar spine during the primary stage of sciatica is defined lateral curvature of the spine. Calf muscles aching legs lose tone and become soft, and later develops weight loss of muscles of the leg and thigh, can receive the paralysis of the extensor muscles of the foot and toes, reduced or absent ankle reflex. In the course of the affected roots determined by the decrease of sensitivity. The tension of nerve trunks causes painful tonic reflexes. These include: symptom Lazega, i.e. the emergence of pain when lifting up straightened his legs in the patient on the back, while bending the legs at the knee causes pain reduction; symptom Bonn - pain when casting legs, bent at the knee and hip joint; the symptom is severe - pain on the affected side with lifting up healthy feet on his back (cross-symptom Lasaga); symptom Neri - pain along the affected spine when bent head in the patient on the back. Painful when pressed spinous processes of the fourth and fifth lumbar vertebrae (back Gara), with the feeling pain in the midline of the abdomen below the navel (the front point Gara).
Breast sciatica is manifested by pain along the intercostal roots. When viral damage to intervertebral nodes develops "shingles" - sharp intercostal pain, aggravated by inhalation, and bubble skin rash in the projection of the affected node.
Neck-shoulder sciatica pain on posterolateral surface of the neck with the spread in the spine, shoulder, arm, axillary area. Pain worse with the bends and turns of the head, lifting his arms above the horizontal level and lead behind his back. During feeling the painful paravertebral points in the cervical spine, the area above - and subclavian basins, the internal surface of the shoulder and forearm during the neurovascular bundle. There is a feeling of numbness, burning, or tingling in hand and shoulder belt along the affected roots, reduces sensitivity and decreased reflexes with biceps and triceps muscles and develop atrophy of the muscles of the hand. Brush becomes swollen, blue, cold, can decrease the pulsation of the radial artery. Often develops neurogenic lesion of the tissues of the shoulder joint, resulting in swelling, pain and limitation of motion in the shoulder with the development of contractures in leading the muscles of the shoulder.
The treatment of sciatica: inside amidopyrine (pyramidonum), analgin 0.25 g 4 times a day, phenylbutazone 0.15 g 3 times a day, with infectious radiculitis penicillin intramuscularly po 000 IU 4 times a day; local use of dry heat in the form of hot-water bottles, bags of hot sand, proglazhivanija warm iron through flannel; rubbing alcohol, burning ointments (snake venom, bee venom, alcohol and chloroform). When discogenic radiculitis recommended bed rest on a flat and hard mattress with putting a round cushion under the waist; treatment by an extension, in which the patient record with straps to elevated to the head end of the bed by the shoulders and chest. Traction own weight is 30-40 minutes 3-4 times a day. With a sharp pain subcutaneous and intramuscular 0,25 - 2% solution novokaina 2-3 ml in places of the greatest pain, intramuscular vitamins: thiamine chloride (B1) - 5% solution of 1 ml and cyanocobalamin (B12) 200 mcg daily. Shows massage and medical gymnastics (flexion, extension, side torso - in lumbosacral radiculitis, abduction of the shoulder, turning his head - when the cervical-thoracic sciatica). Movement should be smooth, gradually increase in volume, not to leave behind the pain. Recommended treatment quartz, inegalitarian. In chronic recurrent radiculitis need of sanatorium-and-Spa treatment at mud and balneological resorts. Persistent and often relapsing, radiculitis treated promptly.


Sciatica (from lat. radicula - spine - is an inflammation of the roots of the spinal cord.
The defeat of the roots can occur at different periods in their move from the spinal cord to the outlet of the spinal canal. Front and rear roots in the output of the spinal cord are Podporina space and converge on the side of its surface, where through special holes in solid and spider shells go further, surrounded by a sheath that are kind diverticula podporinov space; both back in this place are separated from each other. This part of the root Najot (J. Nageotte) called the radicular nerve. Podporina the vagina, a deeper around the back of the spine than around the front, in the lumbar segments comes to sensitive ganglion. Later during his roots are separated from podporinov space and radicular fibrous tissue sheaths Dura. This part of the root Nagot calls mixed radicular nerve. SICAR (J. Sicard) called this part of the nerve and its continuation to plexus antenna wire (funiculus). Mixed radicular nerve is placed in the epidural space and intervertebral hole (Fig. 1).

the cross-section of the spinal cord
Fig. 1. Diagram of the cross section of the spinal cord with roots:
1 - front spine;
2 - rear spine;
3 - arachnoid membrane;
4 - Dura;
5 - the subarachnoid space;
6 - epidural space;
7 - spinal unit.

The defeat of the roots, surrounded by soft shells, and washed by the liquor, begins with the primary lesion shells. Therefore, the defeat of this part of the roots is called leningradtoyota. Defeat vseoblastnoj part of the roots is called sciatica. The sukkar was proposed identical in content, the term "Funiculi". In Soviet medical literature used both terms.
These localization of pathological process differ mainly in the etiology and the frequency of lesions both cut the roots, to a lesser extent by their symptoms.