Sciatica/Herniated Disc

Basics

Description

  • Pain or paresthesia that radiates from the back into buttocks and lower extremity usually distal to knee, with or without sensory or motor deficits:
    • 95% sensitive, 88% specific for herniated disc (HD)
    • 13–40% lifetime prevalence
    • Peaks 4th to 5th decade
    • 2–10% of low back pain
    • 95% L4, L5, or S1 nerve root
    • Half of cases resolve within 1–2 wk, and 90% resolve within 6–12 wk

Etiology

  • Most common: Lumbar disc herniation. Pain from colloidal gel (nucleus pulposus) protrusion (nerve root compression) or extrusion (acute inflammation) and fissures in the surrounding fibrous capsule (annulus fibrosis)
  • Lumbar spinal stenosis common in age >50
  • Risk factors:
    • Flexion-based lifting/twisting
    • Obesity, sedentary lifestyle
    • Smoking, depression, genetic risk

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