Sciatica (Vertebral dysfunction with radiculopathy)

Question 1

What is Sciatica?

Answer 1

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Question 2

Causes

Answer 2

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Question 3

Differentials

Answer 3

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Question 4

Pitfalls

Answer 4

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Question 5

Management

Answer 5

 If abnormal neurological signs (e.g. foot drop) investigate with plain X-ray, CT scan ± MRI.
 Sciatica is a more complex and protracted problem to treat, but most cases will gradually settle within 12 wks if the following approach is used:
•Relative rest for up to 3 d at onset (keep the spine
straight—avoid sitting in soft chairs and for long
periods)
•Resume activity ASAP
•Regular non-opioid analgesics with review as the
patient mobilises
•NSAIDs: 14 d
•If severe unrelieved pain add tramadol 50–100
mg (o) 2–4 times daily (max. 400 mg/d) or
tapentadol SR as necessary, for short-term use
•Consider steroids for acute severe pain, e.g. prednisolone 50 mg for 5 d → 25 mg → taper to 0 (3 wks total)
•Back education
•Exercises—straight-leg raising exercises to pain tolerance
•Swimming
•Traction (with care)
•Epidural anaesthesia (if slow response)

Question 6

What are the most common disc prolapses?

Answer 6

L3–4, L4–5, L5–S1.

Question 7

Guidelines for possible surgical intervention

Answer 7

• Bladder/bowel disturbances
• Progressive motor disturbance (e.g. increased foot drop, quadriceps weakness)
• Intense prolonged pain with no response to 6 wks treatment and imaging shows a lesion corresponding to symptoms