Pain in the distribution of the sciatic nerve, as a rule felt in the buttock, the back of the thigh and the outside and front of the leg, sometimes extending on to the top of the foot, the back of the thigh and the calf, and then along the outer border of the foot towards the little toe. It is often accompanied by pain in the back, or LUMBAGO.
In most cases it is due to a PROLAPSED INTERVERTEBRAL DISC in the lower part of the SPINAL CORD. What probably happens is that degenerative changes take place in the annulus fibrosus (see SPINAL COLUMN) as a result of some special strain – caused, for example, by heavy lifting – or spontaneously. The cushioning disc between the two neighbouring vertebral bodies slips through the rent in the annulus fibrosus, and presses on the neighbouring roots, thus causing the pain. The precise distribution of the pain will thus depend on which of the nerve roots are affected.
Rare causes include a tumour in the spine or spinal column, tuberculosis of the spine, ankylosing spondylitis (see SPINE AND SPINAL CORD, DISEASES AND INJURIES OF) or a tumour in one of the organs in the pelvis such as the UTERUS.
consists essentially of rest in bed in the early stages until the acute phase is over. ANALGESICS, such as aspirin and codeine, are given to relieve the pain. Expert opinion varies as to the desirability of wearing a PLASTER OF PARIS jacket or a specially made corset; also, as to the desirability of manipulation of the spine and operation. Surgeons are selective about which patients might benefit from discectomy (see LAMINECTOMY) but several weeks of disabling pain or the presence of foot-drop are common reasons why it is advised.