The Sciatic nerve is considered the largest single nerve in the human body. It emerges from L4 to S3 of spinal nerves, which amalgamate at the pelvic region to form a Sciatic Nerve.

Spinal discs of the intervertebral column comprise an outer annulus fibrosis and an inner nucleus pulposus. The annulus fibrosus makes a rigid ring around the nucleus pulposus early in human development, and the gelatinous contents of the nucleus pulposus are presented inside the disc. Discs separate the spinal vertebrae, increasing spinal stability and allowing nerve roots to exit properly through the spaces between the vertebrae and the spinal cord.

With the onset of aging, the annulus fibrosis weakens and becomes less rigid, making it at greater risk for a tear. When there is a tear in the annulus fibrosis, the nucleus pulposus may extrude through the incision and press against spinal nerves within the spinal cord, cauda equina, or eliminating nerve roots, causing inflammation, numbness, or excruciating pain.

Other etiological factors include misalignment, enlarging, and roughening of vertebrae or disc degeneration, which

minimizes the diameter of lateral foramen from where nerve roots exit the spine.

The condition occurs when the gel-like center of the spine’s intervertebral disc protrudes from the tear or rupture portion in its outer ring (annulus). This will exert pressure on the nerve roots situated next to the disc. This condition usually occurs during heavy weight lifting.

SPINAL STENOSIS:

This is another compressive spinal canal condition (the space from which the spinal cord runs) that becomes narrow and compresses the spinal cord, sciatica nerves, or cauda equina (a bundle of spinal nerves and spinal nerve rootlets), which passes through it. The resulting narrowing condition causes bone spur, inflammation, or herniated disc, which again reduces the area for the spinal cord that can cause sciatica nerve pain.

This is the slippage of one vertebral segment concerning the next vertebral segment with mechanical symptoms or pain. It is graded based on the slippage of one vertebral body on the adjacent vertebral body. The etiological factors can be acquired, congenital, or idiopathic. It is also a cause of Sciatica itself.

Sometimes, benign or malignant tumors found in spinal or paraspinal areas are also responsible for sciatica nerve pain.

17% of people have sciatic nerves that emerge from piriformis muscles rather than beneath them. When piriformis reduces or spasms due to any injury or aging, it causes sciatic nerve compression. Piriformis syndrome may be suspected as a cause of Sciatica when the spinal nerve roots contributing to the sciatic nerve remain normal, and no spinal disc herniation is apparent.

Pregnancy can also be an etiological factor for sciatica nerve pain, especially in later trimesters. It may be due to the burden of the fetus compressing the sciatic nerve during spasms or sitting position. It is not directly harmful to the mother or fetus. Instead, it indirectly causes discomfort, pain, and a numbing effect on the legs, which may cause falls.

 It includes direct surgical trauma, improper position during anesthesia for any operation, injection of neurotoxic agents, dressings, casts, or faulty fitting orthotics that lead to sciatic nerve compression.

SYMPTOMS:

Significant symptoms of Sciatica include:

· Lower back pain.

· Extreme pain in leg till foot, which is aggravated when sitting.

· The nature of pain is electric shock, which suddenly radiates to the entire leg.

· Hip pain

· A sudden shooting pain which is unable to stand up.

· weakness, numbness

· Difficulty in movement of leg and foot.

· Muscle weakness

· Sometimes, in very severe cases, there is urinary or fecal incontinence

DIAGNOSTIC METHODS:

Sciatica is commonly diagnosed through:

· Patient history includes the nature of pain, duration, intensity, and aggravation.

· Healthcare providers always look for some diagnostic tests beneficial in evaluating Sciatica. It usually includes Lasegue’s test (straight leg raising test). The SLR is considered positive when it induces radiating pain with the course of the sciatic nerve and below the knee between 30 and 70 degrees of hip flexion.

.The b -regard’s test is a modification of the SLR, where ankle dorsiflexion is applied at the end of the SLR. Dorsiflexion minimizes the SLR angle at which the test is positive and can be used to modify neural symptoms from musculoskeletal symptoms.

· The popliteal compression test or posterior tibial nerve stretch sign. The patient can be examined in a sitting or prone position. The examiner flexes the knee and applies pressure on the popliteal fossa, evoking Sciatica.

· Spine X-rays, CT scans, MRIs, electromyography, and nerve conduction velocity studies help evaluate the condition.

SCIATICA TREATMENT:

Sciatic pain can be treated with various therapies to return the patient’s normal functional status and quality of life.

· SELF-CARE MANAGEMENT:

These are helpful measures, and you can take these practices at home, including cold or heat packs; bed rest is not recommended.

Back exercises under the supervision of an expert are recommended to ease your back. Minimize your activities in the first couple of days and slowly restore to your normal activities.

Avoid heavy lifting or bending your back for the first six weeks when pain begins.

· NON-MEDICINAL MANAGEMENT:

The application of a cold or heat pack depends upon the length of the symptoms, stretching activities, use of counter medications such as NSAIDS (non-steroidal anti-inflammatory drugs) like ibuprofen naproxen, well as the use of acetaminophen to those who are allergic to NSAIDS.

Use of muscle relaxant medication, along with the practice of alternative therapies like acupuncture.

Physiotherapy is also very useful in this regard. A physiotherapist who is an expert in this area has a variety of exercises that help restore the patient’s painful condition. It includes stretching exercises and low-impact activities, including walking and swimming.

· MEDICINAL MANAGEMENT:

Certain medication groups and other non-medicinal options can help cure the condition. A short course of NSAIDs, opioids, non-opioid analgesics, muscle relaxants, and anticonvulsants helps reduce neurologic pain and ease the patient’s overall condition.

Sometimes, epidural steroid injection might help restore the patient’s health. In severe cases, for disabling Sciatica, surgery is necessary to cure the root cause like disc herniation, epidural hematoma, etc.