The Lumbosciatica is a pain located near the loins in the lower back, and along the sciatic nerve
. The sciatic nerve
is the longest nerve in the human body and the one with the largest caliber. It stems from several nerve branches coming from the spine
, including the roots of the last two lumbar vertebrae (L4 and L5) and the first three sacral nerves. It then travels through the buttocks, the posterior aspect of the leg
and is divided at the back of the knee
. It ensures the sensitivity and traction of the rear part of the thigh. Lombosciatalgies can cause pain that may extend throughout its route, starting at the lower back and buttocks before passing to the thighs, legs
and toes. Sciatica
is defined as an experience of pain due to the injury or irritation of the nerve. Lumbosciatica is specifically used when the origin comes from irritation of the nerve starting near the vertebrae, and when the pain is felt all along the nerve. This may be due to a rheumatic
disease, an infection or nerve compression by a tumor
or more often a herniated disc between two vertebrae.
In the case of lumbosciatica, the patient feels pain affecting one side of his body, radiating from the lower back to the buttocks and the back of the leg to the foot
. Sensations of electric shock or burns on can be felt. Depending on which nerve root was damaged, the path of the pain may vary slightly.
- In case of the infringement of the L5 root, the pain starts in the buttock, goes through the posterior part of the thigh and down on the side part, onto the knee in a lateral position and the leg (at the lateral malleolus) and sometimes ends up down at the big toe.
- In case of the infringement of the S1 root, pain starts at buttock and the back of the thigh, heads through the knee and leg before affecting the heel and ultimately touching the outer edge of the foot up to the pinkie toe.
The examination of the patient is the first step in seeking to characterize the location of pain, the mode of occurrence, the triggering circumstances, and positions that ameliorate or aggravate the pain. A clinical examination seeks the initial location of the pain in the back, then the precise route. A test called a Lasègue test, triggers pain while the leg of the patient in a supine position, and then gradually as it is raised. The diagnosis can be confirmed by an X-ray
of the spine, an MRI or a CT scan , showing the location of the nerve pain and sometimes identifying a cause.
The treatment of the pain begins with analgesics
and NSAIDs (or non-steroidal anti-inflammatory drugs
). Total rest is not prescribed for lumbosciatica; on the contrary, the doctor advises slight movements with physiotherapy. In some cases, local injections of corticosteroids may improve symptoms. Similarly, some causes are sometimes accessible to surgical treatment to decompress the nerve root. A laminectomy can thus be achieved.