Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management

Abstract

Radicular pain in the distribution of the sciatic nerve, resulting from herniation of one or more lumbar intervertebral discs, is a frequent and often debilitating event. The lifetime incidence of this condition is estimated to be between 13% and 40%. Fortunately, the majority of cases resolve spontaneously with simple analgesia and physiotherapy. However, the condition has the potential to become chronic and intractable, with major socio-economic implications. This review discusses the history, epidemiology, pathophysiology, and natural history of sciatica. A Medline search was performed to obtain the published literature on the sciatica, between 1966 and 2006. Hand searches of relevant journals were also performed. Epidemiological factors found to influence incidence of sciatica included increasing height, age, genetic predisposition, walking, jogging (if a previous history of sciatica), and particular physical occupations, including driving. The influence of herniated nucleus pulposus and the probable cytokine-mediated inflammatory response in lumbar and sacral nerve roots is discussed. An abnormal immune response and possible mechanical factors are also proposed as factors that may mediate pain. The ongoing issue of the role of epidural steroid injection in the treatment of this condition is also discussed, as well as potential hazards of this procedure and the direction that future research should take.

Treinamento aeróbico prévio à compressão nervosa: análise da morfometria muscular de ratos

“…This disuse may occur as consequence of the loss of function derived from paresthesia 2 and pain, caused by the nervous compression 2,4 . in a few weeks of resistance training, individual alterations in the cross-sectional area can be observed in each muscle fiber 9 .…”

“…Sciatic pain, commonly named sciatica, is also found as radiculopathy, lumbosacral radicular syndrome, radicular pain and compression or irritation of nervous root, originates from the compression of the sciatic nerve and is a symptom referred by the trajectory of this nerve and its branches, distributing by the respective dermatomes and myotomes [1][2][3][4] . it is estimated that 40% of the world population will experience it in any time of their lives; however, approximately 1% will present motor or sensitive deficit [2][3][4] , being also one of the main causes for absences, representing an economical and health problem 2 .…”

“…it is estimated that 40% of the world population will experience it in any time of their lives; however, approximately 1% will present motor or sensitive deficit [2][3][4] , being also one of the main causes for absences, representing an economical and health problem 2 . its etiological characterization includes syndrome of the piriformis muscle 2,3 , besides tumor processes, many congenital mechanical, trauma, degenerative, functional conditions, inflammatory and metabolic conditions involving vertebral articulations [1][2][3][4][5][6][7][8] . Commonly, sciatic pain is followed by low back pain due to the compressing of this region, in a situation known and differentiated as lumbosciatica 5,6 .…”

“…Commonly, sciatic pain is followed by low back pain due to the compressing of this region, in a situation known and differentiated as lumbosciatica 5,6 . Other clinical characteristics derived from sciatic compression include paresthesia 7 , decrease of muscular strength 4,7 , claudication 6 , and consequent muscular hypotrophy 3 , leading hence to functional deficit 2 . The muscle fibers are equipped with high capacity of physiological and biochemical adaptation according to the stimuli to which they are submitted, reflecting in size, metabolism and type of muscle fiber [9][10][11] .…”

Efficacy of Acupuncture for the Treatment of Sciatica: A Systematic Review and Meta-Analysis

“…The prevalence ranges from 1.2% to 43% [2]. A number of risk factors are thought to be associated with first-time incidence of sciatica and influence the development of sciatica; these include smoking, obesity, occupational factors, health status, age, gender, and social class [3,4]. According to traditional Chinese medicine (TCM), sciatica belongs to the gallbladder meridian of the foot-Shaoyang (GB) and the bladder meridian of the foot-Taiyang (BL), and the Yanglingquan (GB 34) and Huantiao (GB 30) are two key "acupuncture points" (acupoints) for treating sciatica [5].…”