Chronic and acute vertebrogenic lumbar ischialgia left and right
Lower back pain or vertebral sciatica — causes, symptoms and treatments
Vertebral sciatica — pain syndrome, triggered by problems in the lumbar-sacral part. In this syndrome the characteristic is that the pain «gives» in one or both legs.
Often the pain occurs suddenly, is standard – only one side of the waist, at least – on both sides.
Also rarely there is pain in the buttocks or pain in the hip joint.
After 7 days it starts to spread in the leg, rendering it difficult to fully straighten the injured limb.
Accordingly, the patient begins her spare, does not occur on the whole foot, the leg is in bent condition, there is a serious limp.
Even in a stationary position bad leg is almost always exposed or set aside – the person seeks to not load.
Causes and risk factors
The main reasons that can be caused by vertebrogenic sciatica – awkward movement, lifting too heavy objects. However, to provoke the appearance of such lesions can also:
- constant stress and depression;
- incorrect posture due to pregnancy, excess weight;
- deforming osteoarthritis;
- the herniated disc;
- heavy physical labour or individual sports;
- age after thirty years.
The aches and pains
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Acute sciatica is a:
- Reflected pain, which is irritation of pain receptors of the ligaments, joints capsules, vertebral and other tissue of the spine, a muscle spasm.
- Radicular pain provoked by involvement of the spinal roots, which is characterized by its pressure, inflammation, edema and demyelination.
Radicular pain standard more powerful than the reflex, is often shooting or penetrating in nature, giving the inner part of the area innervated by the nerve root, is accompanied by numbness and paresthesia, loss of tendon reflexes, muscle weakness in this respect.
At the age of 30-50 years, the cause of the lesion is often a herniated disk, even older play an important role other degenerative changes causing narrowing of the openings between the vertebrae.
The reason nekraskova pain are spondylosis, myofascial syndrome involving the muscles of the buttocks, hip arthroscopy.
Vertebral sciatica can be caused by periarthritis of the hip joint.
Sharp pain in lower back and legs may also be the result of a dissecting aortic aneurysm, disorders of the pancreas and colon, gynecological diseases, spondylitis, septic epidurit, fracture due to osteoporosis or spinal lesions metastases.
Chronic vertebrogenic sciatica can occur with the participation of the three pathophysiological components: nociceptive, neuropathic and psychogenic.
In reality, all forms are rarely seen separately. Often they are combined in different ways. Mostly, back pain and gives up with any party, though sometimes the process is bilateral.
Localization of pain
Localization of pain and the nature of the defeat is not clear. The pain can be aching or burning, strong or weak, manifest in the back or in the leg. Pain differs significantly in form, with each form of its manifestation.
Vertebral sciatica can occur and the right and left and is bilateral.
For muscular forms of pain peculiar to the occurrence of spasms of the muscles in the lower back, which severely affected the mobility in this part may be curvature of the spine.
When vegetative-vascular form, is observed burning pain combined with numbness sore feet. It may be paler healthy, it will seem cold to the touch. May cause feelings of heat or chilliness, which may be associated with increased vascular tone.
The pain of this form can also be by changing the position of the body.
Neurodystrophic form one of the most common. It is characterized by a burning pain, this pain increases at night. Often there are trophic changes – thinning of the skin affected part.
Symptoms and diagnosis
The diagnosis is established with the available x-ray confirmation of the pathological process in the lower back, as well as the developed clinical picture that includes these symptoms:
- lower back pain radiating to one or both legs;
- muscle strain of the lower back;
- cramps in the legs;
- numbness and feeling of pins and needles in the legs;
- weakness in the legs when expressed pain syndrome;
- restrictions torso twists at the waist;
- the need to get up from a prone position with support on hand.
Diagnosis of disease should include a complete neurologic examination.
In the neurological examination, confirming the presence of sciatica can also be detected radiculopathy, which is an indication for consultation of a neurosurgeon.
Diagnosis is based on patient complaints, physical examination and subsequent diagnosis that gives a possibility to determine the degree of damage in the lumbosacral part.
For diagnosis necessary data:
- the x-ray of lower back and pelvis;
- computed tomography;
- magnetic imaging of the spine.
Treatment of pain
If diagnosed with the disease, the conservative treatment — physiotherapy.
In the acute phase leading goal of treatment is to eliminate pain and neutralize inflammation.
Therefore, patients are almost always prescribed rest, nonsteroidal anti-inflammatory agents, analgesics, muscle relaxants.
As well as directed by a physician can be therapeutic blockade, physiotherapy. In some cases, also used reflexology.
Once completed the acute phase, the goal of treatment is the restoration of back muscles and ligaments.
Because the basis of conservative treatment become special gymnastics and massage. Perhaps the use of manual therapy, but it is not applicable in the acute form of the disease, especially in the situation when the cause of the pain is the compression of the nerve roots.
Note that lumbago with sciatica is not a disease, it’s only pain, provoked by the violation.
Not radicular violation subsides in 3-6 weeks, radicular, after 6 – 8 weeks.
The disappearance of pain does not mean the recovery, the illness that triggered the onset of pain, must be treated further.
Treatment of chronic rejection requires a special approach. In this situation, the doctor needs to exclude dangerous causes of pain – infection, osteoporosis, tumors. In this situation the treatment will be aimed mainly at increasing the patient’s motor abilities.
Most commonly used non-drug methods – physical therapy, massage, weight reduction, etc. the Main task is the restoration of back muscles and the press. Besides other things, the patient needs to emerge a new pattern of movement, he must avoid movements that cause pain.
Surgical intervention with the defeat of the standard is not required, 90% of patients are cured after conservative treatment.
The operation may be necessary only in individual cases.
For example, when pain syndrome, which fails to neutralize through conservative treatment. Also the operation must be carried out with the compression of the «horse tail», which causes disruption of the pelvis.
So as not to cause recurrence of the disease should adhere to simple tips:
- try not to stand for a long time;
- if you quickly get tired legs, we rely on the support;
- stop wearing high heels;
- if the work is sedentary, you should sit up straight with a cushion under my back and most of the rest – to stand, to walk, to stretch;
- the same is performed, if is brought to travel a lot by car;
- to quit Smoking;
- to get rid of excess weight;
- the first manifestations of exacerbation – the reason for going to the doctor.
The true cause of the disorders is low back pain, does not change the clinical picture that accompanies the pain, but the mechanisms of development of pain syndrome differ significantly dependent on whether the link of pathogenesis involved in a given situation.
This diversity of pathological mechanisms considerably complicates the diagnosis and develop effective treatment algorithms.