Sciatica or sciatic neuralgia is a commoncondition in which one of the spinal nerve roots of the sciatic nerve is compressed resultingin lower back, buttock and leg pain. Sciatic nerve is a large nerve derived from 5 spinalnerve roots: L4, L5, S1, S2 and S3. It runs from the lumbar spine through the buttockdown the leg and the foot on the posterior aspect. There is one sciatic nerve on eachside of the body. Typically, only one side of the body is affected.A typical sciatica pain is described as a sharp shooting pain in the lower back, downthe buttock, thigh and leg on one side of the body. There may also be numbness, burningand tingling sensations. The pain can get
worse with sitting, moving, sneezing, or coughing.The patterns of pain depend on which nerve root is compressed, and follow the dermatomedistribution. The most common cause of sciatica is a herniatedspinal disc. The spinal disc is a soft elastic cushion that sits in between the vertebraeof the spine. With age, the discs become rigid and may crack, the gellike center of thedisc may protrude out and become a herniation outside the normal boundaries of the disc.Disc herniation presses on the nerve root as it exits the spine.In majority of the cases the condition resolves by itself after a few weeks of rest and conservativetreatment. Pain relief, nonsteroidal antiinflammatory
drugs and muscle relaxants may be prescribed.Stretching exercises and physical therapy may be recommended.Surgery may be needed if the pain doesn't go away after 3 months or more of conservativetreatments. The herniated disc may be removed in a procedure called discectomy. Or, in anotherprocedure called laminotomy, part of the bone of the vertebrae may be cut to make room forthe nerve.
How to Read a MRI of a Lumbar Herniated Disc Lower Back Pain Colorado Spine Surgeon
we're going to look now at a lumbar spine MRI of a patient that has a disc herniation and again we see the side view spinal cordending here nerve roots coming out and the white being cerebral spinal fluidthe water these are the vertebra these are the discs the L one two
two three and three four discs arenormal the white on the inside the jelly is full of water the dark plies in thetire normal here at the four five level there is adegenerative disk you don't see the normal white of a normal disc and you see asmall tear in the back of the disc right there at the five one level it looks somewhat like the four fivelevel as it's dark in the disc but you can see a complete rupture atthe back of the disc
and a disc herniation here which isfilling up the spinal canal this is a typical disc herniation you can look at it now from the topdown view and will come down to the five one levelno better yet we will start at three four here and here is thatjelly filled donut the normal jelly on the inside the donut on the outside the sack ofnerves here all of these black dots are
the nerve roots the back of the disc isflat to concave this is normal we come down from that level to the fourfive level and here is a small tear in the back of the disc this is called anannular tear but the nerves behind that tear are not compressed therefore this patient shouldn't haveany nerve pain from this tear we come down to the five one level and here we see a massive herniated disc
you can see on the right side the nervein some of the nerves in the right side are free and open on the left side you'll see that this herniation is compressing the roots here and thispatient has significant left leg pain this is theview of the disc herniation at that level.