How much do you know about sciatica?

Acute sciatica is generally caused by compression of the sciatic nerve, and its incidence is very high. What are the symptomatic characteristics of acute sciatica? What kind of people does this disease tend to occur in?

【Famous Doctor Files】

He Shaoxuan, deputy chief physician of the Department of Trauma Surgery of the Second Affiliated Hospital of Kunming Medical University, member of the Standing Committee of the Microsurgery Branch of Yunnan Medical Association, has long been engaged in clinical diagnosis and treatment of trauma orthopedics and spine surgery.

Sciatica does not refer specifically to a specific disease, but is a group of clinical symptoms caused by compression of the lumbosacral nerve root, mainly manifested as lumbar leg pain, that is, burning and knife-like pain radiating from the lumbosacral nerve pathway through the hip to the lower leg and even the ankle. Sciatica is a symptom that can manifest itself in a variety of disorders, but the most common is lumbar disc herniation.

The main cause of sciatica is the degeneration of the lumbar disc. Our human lumbar spine is made up of a plurality of vertebrae and vertebrae between the intervertebral discs, intervertebral discs by the outer layer of fiber rings and the central nucleus pulposus tissue, extremely elastic and tough, it can cushion the oscillation when we run and jump, while providing a certain degree of micro movement so that we can freely bend, stretch the waist, it and the vertebrae together to form a spinal canal, in order to accommodate and protect the spinal cord and nerve roots traveling through the spinal canal. As we age, the lumbar disc, as one of the body parts, is also degenerating and aging, which is manifested by a decrease in the water content of the nucleus pulposus, a decrease in elasticity, and it is not easy to return to its original state after compression deformation, while the brittleness of the peripheral fibrous ring increases, the toughness decreases, and it is easy to tear after withstanding too much stress. On the basis of these lesions, symptoms may appear if some precipitating factors appear.

Lumbar degenerative disease is the most common cause of sciatica, lumbar degenerative diseases in addition to lumbar disc herniation, but also include lumbar spinal stenosis, lumbar spondylosis, lumbar degenerative scoliosis, etc., this large category of diseases have a common pathological basis, that is, lumbar disc degeneration. Lumbar disc degeneration will lead to intervertebral instability, long-term intervertebral instability will lead to lumbar spondylolisthesis, lumbar degenerative scoliosis and other diseases. The human body has compensatory mechanisms. After intervertebral instability, in order to increase the stability of the intervertebral, the human body will stabilize the lumbar spine through measures such as hypertrophy of the yellow ligament in the spinal canal, hyperplasia and cohesion of the intervertebral articular process, and these abnormal "stability maintenance measures" will inevitably occupy the normal spinal canal space, resulting in spinal stenosis and nerve root compression.

In addition, lumbar disc degeneration and atrophy will lead to intervertebral space stenosis, and shorter intervertebral space stenosis will inevitably lead to foramen stenosis, and the intervertebral foramen is the channel through which nerve roots penetrate, and intervertebral foraminal stenosis is also an important factor in sciatica. In addition to degenerative diseases of the lumbar spine, there are also some diseases that may also produce sciatica, such as lumbar tuberculosis, tumors, piriformis syndrome, certain pelvic diseases in women, and so on.

In order to slow down the degeneration of the lumbar disc, we need to pay attention to all aspects of daily life. As the saying goes, standing like a pine, sitting like a bell, walking like the wind, lying like a bow, from the adolescence to develop good living habits. For friends who already have symptoms, because the intervertebral disc has degenerated, they should not bend down for a long time to work such as washing vegetables, washing dishes, mopping the floor, or directly bending down to carry water, lifting flower pots, etc., do not carry heavy objects, do not bend directly to pick up when things fall to the ground, but straighten your waist and squat down to pick up. In addition, everyone usually needs to do more lumbar back muscle exercises to strengthen the strength of the low back muscles, which can delay the degeneration of the lumbar intervertebral disc.

Treatment of acute lumbar disc herniation is based on the timing of onset. In general, if the onset time is less than 3 months and there is no formal conservative treatment, you can try conservative treatment first, try to stay in bed as much as possible, do the lumbar traction appropriately, 2 times a day, each time for half an hour, while giving oral neurotrophic drugs such as methylcobalamin tablets, nerve analgesics such as pregabalin capsules, and those with severe symptoms may also be intravenously infused with dehydrated drugs such as mannitol. After the treatment of these measures, many patients can be relieved, and some patients will no longer have the disease for life. Of course, there are also some patients who are ineffective after the above conservative treatment, and they can only do surgery. Most of these diseases can now be completed by minimally invasive surgery, with foraminoscopy, and postoperative recovery is fast.

The surgical technology of lumbar spondylolisthesis has developed to a very mature time, as long as everyone chooses a formal and reliable medical institution, the risk of paralysis of the lower limbs is not high. As for age, it is not an absolute factor to judge whether surgery can be done, mainly depends on the patient's underlying disease, if there is no complex underlying disease, such as coronary heart disease, cardiac insufficiency, chronic obstructive pulmonary disease, etc., older patients can also do surgery.

According to the current technical conditions, lumbar spondylolisthesis (especially for those with severe slippage) surgery is best to choose open surgery, because lumbar spondylolisthesis people must have intervertebral instability, only effective intervertebral fusion, completely eliminate instability can ensure long-term efficacy, the most reliable fusion technology is still the traditional open surgery. In addition, even with open surgery, the patient is generally encouraged to walk under the protection of the brace 2-3 days after the operation, and does not need to be bedridden for a long time.

(Source: Yunnan Population and Health Publicity and Education Center)