Sciatica

Sciatica and neck pain are the most common diseases of the musculoskeletal system in our time.

Approximately 80% of people will experience back pain, while 67% will experience pain in the neck area.

Sciatica is generally referred to as any type of pain along the sciatic nerve (from the hips and sometimes to the toes), regardless of the type of injury.

Peripheral or Distal Sciatica is referred to as that which is due to causes not related to the spine

Classification of Injuries

Sciatica injuries are generally classified into the following groups:

1. Compression injuries or friction injuries.
2. Injuries from trauma (contusion, traction, puncture, transection, burn, etc.).
3. A rarer group are pathological lesions such as metabolic lesions due to pathological diseases (e.g. alcoholic neuropathy, diabetic neuropathy, demyelination, etc.) and viral lesions such as postherpetic sciatica after shingles of the sciatic nerve.
4. Cases of patients with symptoms of alleged sciatica who ultimately did not have a problem with the sciatic nerve have been reported. Such cases were multiple myeloma, stroke, cancer metastases to the Femur or Tibia, Paget’s Disease, primary brain tumors, cancer metastases to the brain, multiple sclerosis, etc.

Compressive lesions of the Sciatic Nerve

If we exclude the intervertebral disc herniations in the lumbar spine and lateral spinal stenosis due to degenerative disc disease which are the main causes of sciatica, then all other cases are pressure injuries to the buttock e.g.

• long journey in an uncomfortable position.
• from sleeping in a fixed position after alcohol intoxication).
• pressure on the sciatic nerve from a revolver, a wallet or a hard object in the ”back pocket”.

In these cases, it is a disorder of the nerve’s function due to ischemia of its vessels (Vasa neurorum). Friction damage occurs from the function of the gluteal muscles, especially in over-exercising athletes or in cases of dysplasia of the hip and gluteal rotator muscles.

Sometimes the Piriformis muscle is responsible. In the 1990s, there were some publications that supported the view that a large percentage of sciatica is of extraspinal etiology and that one of the most common causes of this extraspinal sciatica is the “Piriformis Syndrome”, that is, the pressure of the nerve between the Piriformis muscles and the other small abdominal muscles of the hip.

Sciatica

After almost 20 years, it has been proven that “piriformis syndrome” does exist, but it is a small minority in the total sciatica, which unfortunately have in their vast majority a central spinal origin (herniated intervertebral disc, discopathy, central spinal stenosis, lateral spinal stenosis, pressure of the sciatic plexus within the pelvis anterior to the spine, etc.).

Sciatica