La lumbosciatica is a pathology characterized by low back pain (pain in the lower back) associated with pain in the lower limb along the sciatic nerve. In other words, it is a sciatica plus back pain.
In the vast majority of cases, the lumbosciatica is the result of a disco-radicular impingement secondary to a herniated disc lumbar. We then speak of common lumbosciatica.
The management of the latter usually involves treatments pain medication (simple analgesics, or morphine derivatives) and anti-inflammatory (NSAIDs, corticosteroid injections). The regression of symptoms is usually done in a few days, so there is nothing to worry about!
But, sometimes, lumbosciatica can be the clinical expression of a potentially serious pathology such as a tumor or an bone infection. It can also cause unbearable pain and/or very severe symptoms, which can go as far as paralysis of the lower limb! It is therefore important to be able to recognize the signs of severity of this affection.
In this article, we will show you the situations that require emergency care in the event of lumbosciatica !
Lumbar vertebral column: brief anatomical reminder
Our lumbar spine, or Lumbar spine, consists of 5 vertebrae numbered from L1 to L5. These are separated from each other by intervertebral discs, kinds of fibrocartilaginous cushions that act as shock absorbers by absorbing shocks during movement.
Each lumbar vertebra is composed of a vertebral body forward, and a spinal blade back (also called posterior arch). Between these two structures there is a hole called vertebral foramen.
The superposition of the lumbar vertebrae and their vertebral foramens forms what is called the Spinal canal lumbar, a kind of bony tunnel that encloses the lumbar part of the spinal cord.
The spinal cord, at the lumbar and sacral level, gives rise to nerve roots which form a network of nerves called lumbosacral plexus. The latter, in turn, gives rise (among other things) to the most voluminous nerve in the human body: the sciatic nerve, responsible for the sensory-motor innervation of the entire lower limb.
La compression ou nerve irritation sciatica in certain pathologies such as herniated disc lumbar spine, certain tumors or bone infections, causes severe pain throughout the course of this nerve. This is called the sciatic neuralgia, better known as « sciatica ».
Sometimes these sciatic pain are accompanied by low back pain (lower back pain). We will then talk about lumbosciatica rather than sciatica.
What is lumbosciatica?
La lumbosciatica is a condition that associates lower back pain et in the path of sciatic nerve. Most often, it is secondary to a lumbar disc herniation which compresses one or more nerve roots that participate in the formation of the sciatic nerve.
What are the causes of lumbosciatica?
In the majority of cases, sciatica is secondary to a disco-radicular impingement (compression and/or irritation of a nerve root by a bulging or herniated intervertebral disc). We then talk about common lumbosciatica.
Indeed, over time, repetitive strain injuries of everyday life gradually alter and weaken our intervertebral discs, especially those of Lumbar spine. They therefore become less able to withstand the various constraints, especially when standing and walking.
Thus, they may present a bulge which will press on one of the nerve roots of the sciatic nerve at the origin of progressive onset lumbosciatica.
They can also break during a acute trauma (falling, carrying a heavy load, etc.) at the level of their peripheral layer, their pulpy (or gelatinous) nucleus is exteriorized, then compressing a nerve root and causing sudden onset sciatica.
The herniated disc is therefore the most common cause of lumbosciatica. But other causes, rarer, are possible:
- Lumbar osteoarthritis,
- Le narrow lumbar canal (spinal stenosis),
- A tumor process (benign or malignant),
- An infection (spondylodiscitis),
- A vertebral fracture (compression by a bone fragment),
- A spinal slip (spondylolisthesis, retrolisthesis).
How does lumbosciatica manifest?
Lumbosciatica is clinically manifested by low back pain that radiate to the lower limb (characteristic topography according to the compressed lumbar nerve root).
These pains are triggered or exacerbated by physical activity (mechanical type pain), stretching of the lower limb (in particular not the Lasègue maneuver or the test of SLR), The cough and all maneuvers that increase intra-abdominal pressure.
In addition to pain, other symptoms may be observed such as sensory disorders (tingling, tingling, etc.) or motor disorders (muscle weakness) in the lower limbs.
Lumbosciatica: when to worry?
Lumbosciatica is a relatively common condition, the cause of which is, in the vast majority of cases, a herniated disc (common lumbosciatica). Its evolution is generally favorable in a few days thanks to a drug treatment based on more or less powerful analgesics.
However, there are other causes, certainly rarer, but more serious lumbosciatica! In particular the cancers, infections and inflammations.
So here are the warning signs a cas de acute lumbosciatica which can point to a more wicked cause:
- Un age under 20 ou over 50 years old (orientation towards a tumor cause).
- A elective pain which concerns a vertebra (well objectified during the clinical examination with digital pressure).
- Personalized neurological symptoms such as paresis (muscle weakness of the inner limb), the paresthesia (tingling, numbness, tingling, etc.), the sphincter disorders (urinary or faecal incontinence), thesaddle anesthesia or hypoesthesia (total or partial loss of sensitivity)... Especially when these symptoms are intense.
- Personalized persistent pain ou progressively worsening.
- Pains not relieved by rest (non-mechanical looking).
- Un antecedent de cancer (orientation towards a tumor cause, in particular a bone metastasis of a distant cancer).
- A profound asthenia, emaciation unexplained, a perte of appetite and / or deterioration of general condition (direction towards a malignant cause).
- A notion of trauma recent (referral for a vertebral fracture).
- A bilateral involvement (can direct towards a narrow lumbar canal).
- A fever ou feverish state (referral to an infectious cause such as spondylodiscitis, osteomyelitis, epidural abscess, etc.).
- The presence of certain factors such as Addiction (intravenously) and immune deficiency.
What to do in case of sciatica with signs of severity?
In the event of the appearance of one of the warning signs mentioned above, it is necessary at once see a doctor in order to benefit from a exam full clinic (with emphasis on neurological and lumbar spine examination), a biology report (ESR, CRP, blood count formula, etc.) and a imagery (MRI or lumbar scan).
This will allow highlight the causal pathology (tumor, infection, hernia, etc.) in order to be able to adapt treatment (antibiotics, surgery, cancer treatment, etc.) and obtain clinical improvement as quickly as possible.
A hospitalization is sometimes essential, especially in the case of paralyzing lumbosciatica, hyperalgesic or with syndrome ponytail. Ideally, it should be done within a surgical unit specializing in spinal pathologies.
It should be specified that the severe forms of lumbosciatica are quite rare. In the vast majority of cases, it is a benign pathology which regresses in a few days/weeks thanks to a simple medical treatment (spontaneous favorable evolution in two months in general).
Resources
References
[1] M. RACHID and S. El HASSANI, “Survey on the diagnostic and therapeutic management of common low back pain and lumbosciatica of less than three months of evolution”.
[2] R. Thurel, “Lombosciatica by herniated disc”, Acta neurochir, flight. 2, no 1, p. 9‑31, March 1951, doi: 10.1007/BF01406095.
[3] “When should a patient presenting with low back pain/acute low back pain be referred to the emergency room? », Swiss Medical Review. https://www.revmed.ch/revue-medicale-suisse/2010/revue-medicale-suisse-259/quand-referer-aux-urgences-un-patient-presentant-une-lombalgie-lombosciatalgie-aigue (consulted on September 12, 2022).
[4] “Common acute lumbosciatica recommendations – VIDAL”. https://www.vidal.fr/ Maladies/recommandations/lombosciatique-aigue-commune-3527.html#prise-en-charge (accessed September 25, 2022).
[5] E. Legrand, T. Couchouron, P. Insalaco, and M. Audran, “Should a patient suffering from common lumbosciatica be hospitalized? », Rheumatism Review, flight. 71, p. S100-S103, 2004.
My name is Katia, I am specialized web editor in writing medical articles. Being passionate about medicine and writing, I set myself the goal of making medical information accessible to as many people as possible, through the popularization of even more complex scientific concepts.
My name is Katia, I'm 27 years old and I'm a web writer specializing in writing medical articles. Being passionate about medicine and writing, I have set myself the goal of making medical information accessible to as many people as possible, thanks to the popularization of even more complex scientific notions.