Sciatica/Lumbar Radiculopathy

Question 1

Pathogenesis of sciatica?

Answer 1

Disc tear
|
Nucleus pulposis can herniate/prolapse through tear
|
Disc material impinges on an exiting nerve = pain and altered sensation

Question 2

Commonest site for disc material impinging on nerve root?

Answer 2

L4
L5
S1- Sciatic nerve

Question 3

Symptoms of sciatica?

Answer 3

• Altered sensation in dermatomal distribution & reduced power in myotomal distribution
• Reflexes may be reduced
• Radicular pain (neuralgic burning/tingling

Question 4

Signs of sciatica?

Answer 4

• Positive sciatic stretch test

- Cross-over sign

Question 5

What is the cross-over sign?

Answer 5

Sciatic stretch testing of opposite side produces pain on affected side

Question 6

L3/4 leads to which root entrapment?

Answer 6

L4

Question 7

Symptoms of L4 root entrapment?

Answer 7

• Pain down to medial ankle (L4)
• Loss of quadriceps power
• Reduced knee jerk

Question 8

L5 root entrapment has which prolapse?

Answer 8

L4/L5

Question 9

Symptoms of L5 root entrapment?

Answer 9

• Pain down dorsum of foot

- Reduced power of extensor hallucis longus & tibialis anterior

Question 10

Which root is entrapped by and L5/S1 prolapse?

Answer 10

S1 root entrapment

Question 11

Symptoms of S1 root entrapment?

Answer 11

• Pain to sole of foot
• Reduced power of plantarflexion
• Reduced ankle jerks

Question 12

1st line of treatment for sciatica?

Answer 12

Analgesia
Maintaining mobility
Physiotherapy

Question 13

Treatment for sciatica?

Answer 13

• Occasionally drugs for neuropathic pain (Gabapentin)
• Majority of prolapses resolve spontaneously
• Occasionally surgery