The lumbosciatica is the association of two symptoms, What are low back pain and sciatica?. It's a symptom, so it means that there are different pathologies that can cause it.
The lumbar pain it is called the one that is located in the region that runs from the gluteal area to the first lumbar vertebra, about rib height. This can be mechanical or inflammatory.
The sciatica, for his part, It is called that pain that is caused by irritation of the sciatic nerve, neuropathic pain, characterized by severe pain running down the leg and associated with leg cramps, weakness and changes in sensation. In most cases, the irritation originates at the level of the lumbar spine..
Index
Types of lumbosciatica
The lumbosciatica can be classified according to the time of onset of symptoms. It is considered that there is a lumbosciatica when it lasts less than six weeks; and it is considered that there is chronic lumbosciatica in the event that the symptoms last over time beyond three months.
If it lasts between three and six months, is considered to be a subacute lumbosciatica.
Causes of lumbosciatica
There are different pathologies that can cause you to suffer from lumbosciatica, the main ones being the following:
Herniated disc
The intervertebral disc is composed of a fibrous collagen ring that has a nucleus pulposus with a gelatinous consistency.. When a rupture of the mentioned ring occurs, this core material can leak out, thus giving rise to what is known as herniated disc.
The annulus fibrosus is surrounded by different nerve endings., and when the fibers of the annulus break and the nucleus comes into contact with the endings it irritates them, thus causing lower back pain, and if what is irritated are the nerve roots, what will be suffered will be a sciatica. Depending on the affected nerve root, the symptoms that will be suffered in the leg will vary..
Spondylolisthesis
A spondylolisthesis is the displacement of one vertebra over another. This is what is called spinal instability.. When there is an excess of movement in the vertebra, low back pain originates., when the vertebra moves, the caliber of the lumbar canal is reduced, thus giving rise to the compression of its neurological structures and causing sciatica.
spinal fracture
When a vertebra breaks it can cause lower back pain.. On some occasions it can happen that one of the fragments of the vertebra can compress a nerve root and thus cause a sciatica.
Tumors
A fourth cause of lumbosciatica is the disease of a tumor, that when it grows it weakens the vertebra, can lead to a spinal fracture. What's more, the tumor as it grows can compress the neurological structures, and that's when sciatica kicks in.
Diagnosis
For the diagnosis of a lumbosciatica resorts to the use of:
- X-rays. Through an X-ray, the presence of a fracture can be assessed., in addition to being able to observe the existence of some instability, the degree of vertebral degeneration and sometimes tumors can even be diagnosed.
- TAC. Through CT, the different bone structures can be assessed with more definition than in an X-ray, in addition to being able to assess whether there are disc herniations and knowing the diameter of the medullary canal. CT is considered the best test with which to determine if you have vertebral fractures.
- Magnetic resonance. The magnetic resonance It is the best test to be able to make an assessment of the spinal canal and disc herniations.. Through MRI it is possible to check the presence of tumors as well as the assessment of fractures that when they are slight can go unnoticed in the X-rays.
Treatment of lumbosciatica
When carrying out the treatment of lumbosciatica It is important to distinguish between two types of treatment:
Conservative treatments
Among the conservative treatments lumbosciatica we find the following:
- Medication. It is indicated for periods that do not exceed two weeks as well as in the exacerbations of chronic lumbosciatica. For this, the use of analgesics and anti-inflammatory drugs can be resorted to., and even muscle relaxants could be applied.
- Physiotherapy. Linked to medication, it is common for physiotherapy treatments to be introduced, such as dry needling or mesotherapy, among others.
- infiltrations: There are different types of injections that can be used to improve a lumbosciatica. You can resort to the use of facet blocks or carry out a rhizolysis with which to treat low back pain, epidural infiltrations or foraminal infiltrations that help improve sciatica.
Surgical treatments
There are countless techniques that can be used to treat a problem of lumbosciatica, opting for one or the other depending on the cause that originated it. Some of the options that can be used:
- Nucleolisis. It consists of the dehydration of the intervertebral disc, so that the pressure it exerts on the nerve endings is reduced. It is indicated for contained protrusions and hernias.
- spinal endoscopy. It is the most advanced technique to treat lumbosciatica, being able to treat those that originate from a herniated disc, for canal stenosis or perform a spinal fusion.
- Discectomy and laminectomy: Are the traditional surgical techniques, which are used to decompress nerve roots. These require an incision 4-5 centimeters and to access the canal and cut muscle and part of the facet joint.
- Vertebral fusion. In cases of spondylolisthesis, in which the disc degeneration is very advanced or to decompress the nerve structures a lot of bone has to be removed, a spinal fusion should be associated with the discectomy or laminectomy. In this sense, there are different ways to perform a spinal fusion., that depend on the pathology suffered by the patient, as well as by the surgeon's own experience.