Dr. Ebraheim’s educational animated video illustrates the condition of Sciatica nerve pain and its diagnosis.
About 3 million people suffer from sciatica and the condition usually resolves itself within a few weeks to a few months.
A few patients may end by surgery.
This problem of sciatica can be self- diagnosed.
What is sciatica?
It is a pain radiating along the course of the sciatic nerve which runs from the lower back to the buttock, through the back of the thigh and into the lower leg and foot.
Sciatica pain usually affects one side of the body.
Sometimes this pain is called “lumbar radiculopathy” or “true sciatica”.
Sciatica is not a diagnosis; it is a symptom of an underlying condition.
Sciatica Pain:
Pain is worse when sitting because sitting will place tension on the nerve, stretch it, and make it irritated and painful.
The pain is a nerve pain, it is sharp, shooting pain like electric shock, running down the leg with burning, tingling, pins and needles, the pain could radiate to the leg and the foot, and there might be some numbness.
The sciatic nerve originates from 5 nerve roots: from L4, L5, S1, S2, and S3.
All the 5 nerve roots join together to form the sciatic nerve, then it branch out again in the thigh and the leg to give multiple muscular/ motor and sensory functions to specific areas and specific muscles in the leg and foot.
What is the cause of the sciatica?
1- Lumbar disc herniation:
– A disc is a cushion between the vertebrae.
– These vertebrae have a soft inner material that may leak out or herniate from the disc through a tear in the outer fibrous layer, becoming a disc herniation.
– This irritates the close-by nerve root.
– Sciatica is one of the most common symptoms of lumbar disc herniation.
– MRI is the best study for diagnosing lumbar disc herniation.
– 90% of the patients will improve within about one month with nonoperative care such as: rest, physiotherapy, anti-inflammatory medication.
When do you do surgery?
When there is progressive weakness or persistent disabling pain for more than 6 weeks.
Who is a good candidate for surgery?
– A good surgery candidate will have: 1- sciatica (leg pain), 2- tension sign (positive straight leg raise), 3- abnormal neurological findings, 4- MRI finding which is consistent with the neurological examination.
What kind of surgery?
– Laminotomy.
– Discectomy.
– Surgery is better and is quick in recovery than no surgery.
– Surgery will cause improvement in the pain, in the function and satisfaction, however there is no significant difference in work status between surgery and no surgery at four years.
– After surgery, the patient can return to intense activity at 4-6 weeks.
2- Degenerative disc disease:
– Bony spur (osteophytes) may develop and press against the nerve.
– An L4-L5 disc involvement will affect the L5 nerve root.
3- Isthmic Spondylolisthesis.
– There are Pars defect, so the pars defect allows one vertebral body to slip forward on the other.
– Slip is a big deal, it is not a disc slipping, it is a slipping of the vertebral body.
– Slipping at the L5-S1 will involve the L5 nerve root.
– Slipping L4-L5 will compress the L4 nerve root.
– Slipping of the vertebral body cause the disc space to collapse and stress fracture, all will have the nerve to be pinched.
4- Lumbar Spinal Stenosis:
– Narrowing of the spinal canal and narrowing of the intervertebral foramen (nerve root canal).
– Hypertrophy of the facet joint, hypertrophy of the ligamentum flavum, disc degeneration, or arthritis are all examples of conditions which constrict the nerve root canals causing compression of the spinal nerves and sciatica.
– The patient will have back pain that is better with flexion, or leaning forward over a shopping cart.
– The pain will be worse with extension of the back.
– The patient will have leg pain, weakness, cramps, burning and heavy sensation.
– Neuroliogical examination is normal in over 50% of the patients and the straight leg raising is rarely positive.
– Differential diagnosis:
• hip disease or arthritis.
• Metastatic disease.
• Vascular problems.
– Every case that you suspect to be lumbar stenosis, suspect a
5- The Periformis Syndrome:
– The nerve could be irritated where it runs under the periformis muscle in the buttock.
– When the periformis muscle irritates the sciatic nerve, it causes sciatica.
6- Sacroiliac Joint Dysfunction:
– This doesn’t cause true radiculopathy, however the symptoms sometimes mimic radiculopathy or mimic periformis syndrome, and the clinician should be aware that these three entities can overlap and can mimic each other.
Thank you so much for your clear explanations! I really, really appreciate it & yes, you are very, VERY helpful !! 🙂
Very clear explanation and exact to the point… That’s what I’m experiencing.
True..
Can i tell u. Almost a year now
Couldn’t get better possible explanation than this! 👏👏👏
Thank you, doctor, for you clear explanation and attractive visuals of various spinal disorders. Unfortunately for me I have several and they have worsen. I will need, therefore, to seek a re-evaluation if my spinal conditions and exploration of medical treatments and interventions that will help to alleviate my pain and restore or improve my movements. Your YouTube presentations on some of my spinal disorders will help me be a more informed patient and active participant in subsequent medical discussions and decisions. Retired Psychologist, East Berlin, PA, USA June 2020
This is possibly the most informative video on this topic I’ve seen after viewing many.Great video and yes,helpful.
it happened to me yesterday and the pain is unbearable, thank you for the useful info Doc!
What Digionositic you did for that
Very very …clear explanation ….thank u sir ..🙏 I’m suffering these symptoms ..which helps to me to diagnose
👍
Oh my! What a wonderful explanation!!! When I’ve been in pain for so long, I can now make sense out of it! And it doesn’t help when you’ve got more than one symptom.
Thank you, thank you, thank you!!!!
God bless you for this knowledge that you’ve shared with us. For most of us who are dealing with this issue no matter what the cause. Thank you for your knowledge and dedication and sharing this with the rest of us, God bless you!
Very informative. Thank you. By chance would you happen to have a chart comparing the difference(s) of all the 5 conditions side-by-side including causes, symptoms, treatments, etc. At minimum?
Very helpful explanation and presentation . It is presented in such a way that even someone with no knowledge of health science may understand it and make the necessary decision for the relief when faced with.
Llpp
This is exactly what am going through now, pinched nerves, am presently doing some physical therapy,, but the muscle cramp is unbearable
@YaNe H.J Encounter Ministries YouTube page. (Mark Hemans)#+
That would be very helpful for me too!
Excellent presentation. Feel an informed, no-nonsense, matter of fact description of possible causes. Clinical approach is much more sober, yet honest. Thank you for simplifying, yet not condescending for the layperson!
Thank you for the knowledge. I’m diagnosed with herniated disc at L4 and S1 with symtoms of sciatica at right leg. The pain is unbearable.
Very helpful. Appreciate very much. Have several of the symptoms and this helped me to understand better.
Have you found anything helpful? I hope so
Yes, that shock pain goes in my left foot. it lasts for at least 10 seconds. it might pop up maybe one or two times within an 8 hour period.
Thanks for this ground-breaking knowledge that comes at no cost. God bless you, doctor.
Very informative. I will be presenting this to my GP because he don’t seem to understand my condition, even with MRI, CT and X-ray images. He is steering me towards a neurologist after having been to 3 different neuro surgeons. I have a herniated disk with osteoarthritis.
You can make your own by using Microsoft Word and adding tables as needed. You can also use Excel.
Very clear and helpful explanation.I have a disk problem and also sciatica .😔
Very informative and interesting. I can now understand how this symptom is caused. Treatment options, besides surgery, would be greatly appreciated.
👍🏽👍🏽thumbs up thank you.yes U were very very helpful grateful.🙏🏽
God bless you evrithing you sheared with us…
Great explanation for something I’ve been suffering for 40 years. Thank you.
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