New Research: Top 3 Breakthroughs in Back Pain Relief

New Research: Top 3 Breakthroughs in Back Pain Relief

Wearable Smart Devices for Real-Time Pose Modification


The Function of Wearable Smart Gadgets in Reinventing Back Pain Treatments


As we enter the advanced landscape of healthcare in 2025, back pain continues to be a consistent disorder influencing millions worldwide. 5 Revolutionary Back Pain Treatments to Try in 2025 . Nevertheless, the arrival of wearable wise tools for real-time posture adjustment attracts attention as a sign of advancement, promising a revolutionary technique to reducing this olden trouble. This essay delves into the transformative capacity of such tools in the world of neck and back pain treatments.


Gone are the days when neck and back pain patients count only on regular check outs to a physiotherapist or chiropractic doctor. With the introduction of wearable clever tools customized for pose correction, people are now equipped to take charge of their spinal health in genuine time. These sophisticated devices are ingeniously designed to be lightweight, unobtrusive, and flawlessly incorporated right into the daily lives of users.


At the heart of these gadgets exists the advanced blend of sensing units and artificial intelligence. Sensors continuously check the wearers pose throughout the day, detecting slouches, misalignments, and any deviations from a healthy spinal curvature. When inadequate pose is recognized, the device sends gentle resonances or acoustic hints, prompting the individual to adjust their setting. This instantaneous responses loophole not only helps in fixing posture in the moment but also educates the muscles and mind to preserve an ideal posture over time, effectively lowering stress and stress and anxiety on the back.


Moreover, the real-time data accumulated by these devices supplies very useful insights right into postural habits, aiding individuals to recognize patterns and tasks that add to their pain in the back. By syncing with smartphones or various other wise modern technologies, the tool can use personalized advice, exercises, and even relaxation strategies, all tailored to the users details demands and progression.


The ramifications of this technology are profound for preventative treatment. By resolving poor position prior to it comes to be a chronic issue, these wearable devices have the possible to substantially lower the incidence of back pain, which in turn might lower the requirement for more intrusive therapies like surgery or long-term medicine.


Additionally, the assimilation of such tools into telehealth services enhances the extent of remote diagnosis and treatment. Individuals can share their pose data with doctor, permitting even more exact assessments and customized treatment plans without the demand for frequent in-person brows through.


To conclude, as we aim to 2025 and beyond, wearable smart gadgets for real-time position improvement attract attention as an innovative treatment for back pain. By combining the convenience of wearable modern technology with the precision of real-time information, these devices supply a positive strategy to spinal

Gene Treatment for Long-Term Pain Alleviation


Gene Therapy for Long-Term Pain Relief: A Glance into the Future of Pain In The Back Administration


The year is 2025, and the landscape of back pain treatment is experiencing a transformative period, defined by innovation and sophisticated modern technology. Among the most cutting edge therapies that have arised, gene therapy stands apart as a beacon of expect those that experience persistent pain in the back. This novel strategy is not just introducing in its methodology however also promises lasting relief, which has actually been a distant dream for many patients.


Gene treatment for back pain operates a concept that is as stylish as it is intricate-- it includes the adjustment of a people genetics to treat or stop disease. In the context of pain in the back, this treatment targets the hereditary elements that add to the swelling, nerve damages, and cells degeneration that are often at the origin of relentless pain.


The process of genetics treatment starts with the recognition of details genetics that affect pain feeling or inflammatory feedbacks. Researchers have made significant strides around, determining genetic markers that can be controlled to decrease pain without the need for repetitive medicine regimens. As soon as these genes are recognized, a harmless infection or another vector is genetically crafted to carry healthy and balanced or modified genes into the human cells.


Patients going through genetics therapy for pain in the back obtain an injection straight right into the affected location of the spinal column. This local approach guarantees that the restorative genes reach the intended site, using a targeted treatment that minimizes systemic adverse effects. The presented genes after that function to either suppress the overactive pain signals or advertise the healing of damaged cells.


What sets genetics therapy besides standard pain administration methods is its possibility for resilient alleviation. As opposed to covering up signs and symptoms with pain relievers or undertaking intrusive surgeries, clients can anticipate a future where their bodys own hereditary makeup is taken advantage of to deal with pain from within. As the modified genes incorporate into the patients DNA, the restorative results can maintain for several years, substantially improving the lifestyle for those affected with persistent neck and back pain.


In addition, gene treatment is customized. Each treatment can be tailored to the people genetic profile, enhancing the efficiency and lowering the likelihood of damaging responses. This bespoke method to pain management proclaims a brand-new period of accuracy medicine, where treatments are designed to suit each people one-of-a-kind hereditary blueprint.


The guarantee of genetics therapy for long-term pain alleviation is not without its challenges. The road to widespread medical application has been paved with strenuous screening, honest considerations, and governing authorizations. Nonetheless, the strides made

Digital Reality as a Tool for Persistent Neck And Back Pain Monitoring


Digital Fact as a Tool for Chronic Pain In The Back Management: A Glance into the Future of Healing


As we venture deeper right into the 21st century, the world of pain administration is undergoing an improvement, one that merges the boundaries in between technology and human experience. Virtual Truth (VR), once an invention of science fiction, has now come to be a beacon of hope for those struggling with chronic pain in the back. In the advanced landscape of 2025, virtual reality isn't simply a device for amusement however a cutting edge therapeutic method that is redefining the method we come close to neck and back pain treatment.


The idea of utilizing VR for persistent back pain administration stems from its ability to immerse clients in an alternative reality, one where the constraints and discomforts of their physiques can be transcended. This immersive experience is greater than just a distraction; it's a type of cognitive behavior modification that shows individuals just how to much better recognize and handle their pain.


In a common virtual reality pain in the back administration session, clients wear a virtual reality headset and are transferred to tranquil settings, be it a sunlit forest glade or a relaxed coastline. These settings are not random; they are diligently crafted to advertise leisure and mindfulness. The client engages in led exercises and activities designed to advertise motion, flexibility, and strength, all within the convenience of a virtual world that reduces the concern of pain that commonly goes along with physical treatment.


The science behind this innovative approach depends on the minds ability to be fooled by virtual stimuli. As people navigate their digital surroundings, their minds are coaxed right into creating pain-inhibiting reactions. This sensation, referred to as "" VR analgesia,"" has actually shown appealing results in decreasing the assumption of pain. Moreover, VRs interactive nature motivates active involvement, which is essential in the rehab process.


The psychological advantages of virtual reality treatment are just as remarkable. Persistent neck and back pain can typically lead to depression, anxiety, and a sense of seclusion. With virtual reality, people connect with a neighborhood of fellow sufferers and healthcare providers, cultivating a sense of assistance and sociability that is crucial for psychological well-being. They find out coping techniques and mindfulness techniques that not only help manage pain but likewise boost their overall quality of life.


As we embrace these introducing therapies in 2025, we see a change from a dependence on pharmaceuticals to a more holistic technique to pain management. VR treatment is not a standalone cure however a corresponding treatment that boosts standard therapies such as physical therapy, medication, and interventional treatments. It represents a tailored technique,

Custom-made 3D-Printed Back Implants and Supports


In the advancing landscape of medical innovation, the world of orthopedic treatment has actually been especially revolutionized by the introduction of personalized 3D-printed spine implants and supports. As we look towards 2025, this ingenious strategy stands as a sign of hope for those experiencing chronic neck and back pain, proclaiming a new era of personalized and effective treatment alternatives.


Custom-made 3D-printed spinal implants and assistances are an item of the marital relationship in between advanced imaging techniques and cutting-edge 3D printing technology. By making use of comprehensive scans of an individuals unique back composition, medical professionals can currently make implants and supports that are tailored to the people details demands. This level of personalization makes sure that the implants fit flawlessly, minimizing the risk of rejection and difficulties that can occur from uncomfortable, mass-produced options.


The implications for back pain victims are profound. For many, traditional back surgical treatment can be a complicated possibility, with long recovery times and the potential for only partial remedy for pain. However, with the precision used by 3D printing, cosmetic surgeons can target the affected area with a much higher level of accuracy, bring about more successful results. This can lead to considerably minimized pain, boosted movement, and a quicker go back to day-to-day activities.


Moreover, the products made use of in 3D printing can be selected for their compatibility with the human body and their toughness. This implies that the implants can be designed not only to give architectural assistance yet additionally to assist in the bodys natural recovery processes. Some 3D-printed products can even advertise bone growth, leading to a stronger, a lot more integrated repair work gradually.


For those with degenerative conditions or complex spinal problems, customized 3D-printed implants stand for a breakthrough onward. Patients that might have dealt with a lifetime of pain and minimal mobility currently have the possible to delight in a more active and comfortable life. The level of personalization in the implants can address the origin of pain with unprecedented accuracy, decreasing the demand for pain medicines and further treatments.


In 2025, as this innovation comes to be much more widespread and accessible, we can prepare for a considerable shift in exactly how neck and back pain is dealt with. Customized 3D-printed spine implants and assistances will likely come to be the requirement of treatment, offering hope and healing to the countless individuals affected by back pain. This is genuinely a cutting edge advancement; one that promises to redefine the limits of spine treatment and recover the lifestyle to many patients worldwide.

Sciatica
Other names Sciatic neuritis, sciatic neuralgia, lumbar radiculopathy, radicular leg pain
Anterior view showing the sciatic nerve going down the right leg
Pronunciation
Specialty Orthopedics, neurology
Symptoms Pain going down the leg from the lower back, weakness or numbness of the affected leg[1]
Complications Loss of bowel or bladder control[2]
Usual onset 40s–50s[2][3]
Duration 90% of the time less than 6 weeks[2]
Causes Spinal disc herniation, spondylolisthesis, spinal stenosis, piriformis syndrome, pelvic tumor[3][4]
Diagnostic method Straight-leg-raising test[3]
Differential diagnosis Shingles, diseases of the hip[3]
Treatment Pain medications, surgery,[2] physical rehabilitation
Frequency 2–40% of people at some time[4]

Sciatica is pain going down the leg from the lower back.[1] This pain may extend down the back, outside, or front of the leg.[3] Onset is often sudden following activities such as heavy lifting, though gradual onset may also occur.[5] The pain is often described as shooting.[1] Typically, symptoms occur on only one side of the body;[3] certain causes, however, may result in pain on both sides.[3] Lower back pain is sometimes present.[3] Weakness or numbness may occur in various parts of the affected leg and foot.[3]

About 90% of sciatica is due to a spinal disc herniation pressing on one of the lumbar or sacral nerve roots.[4] Spondylolisthesis, spinal stenosis, piriformis syndrome, pelvic tumors, and pregnancy are other possible causes of sciatica.[3] The straight-leg-raising test is often helpful in diagnosis.[3] The test is positive if, when the leg is raised while a person is lying on their back, pain shoots below the knee.[3] In most cases medical imaging is not needed.[2] However, imaging may be obtained if bowel or bladder function is affected, there is significant loss of feeling or weakness, symptoms are long standing, or there is a concern for tumor or infection.[2] Conditions that can present similarly are diseases of the hip and infections such as early shingles (prior to rash formation).[3]

Initial treatment typically involves pain medications.[2] However, evidence for effectiveness of pain medication, and of muscle relaxants, is lacking.[6] It is generally recommended that people continue with normal activity to the best of their abilities.[3] Often all that is required for resolution of sciatica is time; in about 90% of cases, symptoms resolve in less than six weeks.[2] If the pain is severe and lasts for more than six weeks, surgery may be an option.[2] While surgery often speeds pain improvement, its long term benefits are unclear.[3] Surgery may be required if complications occur, such as loss of normal bowel or bladder function.[2] Many treatments, including corticosteroids, gabapentin, pregabalin, acupuncture, heat or ice, and spinal manipulation, have only limited or poor evidence supporting their use.[3][7][8]

Depending on how it is defined, less than 1% to 40% of people have sciatica at some point in time.[4][9] Sciatica is most common between the ages of 40 and 59, and men are more frequently affected than women.[2][3] The condition has been known since ancient times.[3] The first known modern use of the word sciatica dates from 1451,[10] although Dioscorides (1st-century CE) mentions it in his Materia Medica.[11]

Definition

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Sciatica often results in pain radiating down the leg.

The term "sciatica" usually describes a symptom—pain along the sciatic nerve pathway—rather than a specific condition, illness, or disease.[4] Some use it to mean any pain starting in the lower back and going down the leg.[4] The pain is characteristically described as shooting or shock-like, quickly traveling along the course of the affected nerves.[12] Others use the term as a diagnosis (i.e. an indication of cause and effect) for nerve dysfunction caused by compression of one or more lumbar or sacral nerve roots from a spinal disc herniation.[4] Pain typically occurs in the distribution of a dermatome and goes below the knee to the foot.[4][6] It may be associated with neurological dysfunction, such as weakness and numbness.[4]

Causes

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Risk factors

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Modifiable risk factors for sciatica include smoking, obesity, occupation,[9] and physical sports where back muscles and heavy weights are involved. Non-modifiable risk factors include increasing age, being male, and having a personal history of low back pain.[9]

Spinal disc herniation

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Spinal disc herniation pressing on one of the lumbar or sacral nerve roots is the most frequent cause of sciatica, being present in about 90% of cases.[4] This is particularly true in those under age 50.[13] Disc herniation most often occurs during heavy lifting.[14] Pain typically increases when bending forward or sitting, and reduces when lying down or walking.[13]

Spinal stenosis

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Other compressive spinal causes include lumbar spinal stenosis, a condition in which the spinal canal, the space the spinal cord runs through, narrows and compresses the spinal cord, cauda equina, or sciatic nerve roots.[15] This narrowing can be caused by bone spurs, spondylolisthesis, inflammation, or a herniated disc, which decreases available space for the spinal cord, thus pinching and irritating nerves from the spinal cord that become the sciatic nerve.[15] This is the most frequent cause after age 50.[13] Sciatic pain due to spinal stenosis is most commonly brought on by standing, walking, or sitting for extended periods of time, and reduces when bending forward.[13][15] However, pain can arise with any position or activity in severe cases.[15] The pain is most commonly relieved by rest.[15]

Piriformis syndrome

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Piriformis syndrome is a condition that, depending on the analysis, varies from a "very rare" cause to contributing up to 8% of low back or buttock pain.[16] In 17% of people, the sciatic nerve runs through the piriformis muscle rather than beneath it.[15] When the piriformis shortens or spasms due to trauma or overuse, it is posited that this causes compression of the sciatic nerve.[16] Piriformis syndrome has colloquially been referred to as "wallet sciatica" since a wallet carried in a rear hip pocket compresses the buttock muscles and sciatic nerve when the bearer sits down. Piriformis syndrome may be suspected as a cause of sciatica when the spinal nerve roots contributing to the sciatic nerve are normal and no herniation of a spinal disc is apparent.[17][18]

Deep gluteal syndrome

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Deep gluteal syndrome is non-discogenic, extrapelvic sciatic nerve entrapment in the deep gluteal space.[19] Piriformis syndrome was once the traditional model of sciatic nerve entrapment in this anatomic region. The understanding of non-discogenic sciatic nerve entrapment has changed significantly with improved knowledge of posterior hip anatomy, nerve kinematics, and advances in endoscopic techniques to explore the sciatic nerve.[20][21] There are now many known causes of sciatic nerve entrapment, such as fibrous bands restricting nerve mobility, that are unrelated to the piriformis in the deep gluteal space. Deep gluteal syndrome was created as an improved classification for the many distinct causes of sciatic nerve entrapment in this anatomic region.[21] Piriformis syndrome is now considered one of many causes of deep gluteal syndrome.[20]

Endometriosis

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Sciatic endometriosis, also called catamenial or cyclical sciatica, is a sciatica whose cause is endometriosis. Its incidence is unknown. Diagnosis is usually made by an MRI or CT-myelography.[22]

Pregnancy

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Sciatica may also occur during pregnancy, especially during later stages, as a result of the weight of the fetus pressing on the sciatic nerve during sitting or during leg spasms.[15] While most cases do not directly harm the woman or the fetus, indirect harm may come from the numbing effect on the legs, which can cause loss of balance and falls. There is no standard treatment for pregnancy-induced sciatica.[23]

Other

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Pain that does not improve when lying down suggests a nonmechanical cause, such as cancer, inflammation, or infection.[13] Sciatica can be caused by tumors impinging on the spinal cord or the nerve roots.[4] Severe back pain extending to the hips and feet, loss of bladder or bowel control, or muscle weakness may result from spinal tumors or cauda equina syndrome.[15] Trauma to the spine, such as from a car accident or hard fall onto the heel or buttocks, may also lead to sciatica.[15] A relationship has been proposed with a latent Cutibacterium acnes infection in the intervertebral discs, but the role it plays is not yet clear.[24][25]

Pathophysiology

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The sciatic nerve comprises nerve roots L4, L5, S1, S2, and S3 in the spine.[26] These nerve roots merge in the pelvic cavity to form the sacral plexus and the sciatic nerve branches from that. Sciatica symptoms can occur when there is pathology anywhere along the course of these nerves.[27]

Intraspinal sciatica

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Left: Illustration of herniated spinal disc, superior view. Right: MRI showing herniated L5-S1 disc (red arrow tip), sagittal view.

Intraspinal, or discogenic sciatica refers to sciatica whose pathology involves the spine. In 90% of sciatica cases, this can occur as a result of a spinal disc bulge or herniation.[14][28] Sciatica is generally caused by the compression of lumbar nerves L4 or L5 or sacral nerve S1.[29] Less commonly, sacral nerves S2 or S3 may cause sciatica.[29]

Intervertebral spinal discs consist of an outer anulus fibrosus and an inner nucleus pulposus.[14] The anulus fibrosus forms a rigid ring around the nucleus pulposus early in human development, and the gelatinous contents of the nucleus pulposus are thus contained within the disc.[14] Discs separate the spinal vertebrae, thereby increasing spinal stability and allowing nerve roots to properly exit through the spaces between the vertebrae from the spinal cord.[30] As an individual ages, the anulus fibrosus weakens and becomes less rigid, making it at greater risk for tear.[14] When there is a tear in the anulus fibrosus, the nucleus pulposus may extrude through the tear and press against spinal nerves within the spinal cord, cauda equina, or exiting nerve roots, causing inflammation, numbness, or excruciating pain.[31] Inflammation of spinal tissue can then spread to adjacent facet joints and cause facet syndrome, which is characterized by lower back pain and referred pain in the posterior thigh.[14]

Other causes of sciatica secondary to spinal nerve entrapment include the roughening, enlarging, or misalignment (spondylolisthesis) of vertebrae, or disc degeneration that reduces the diameter of the lateral foramen through which nerve roots exit the spine.[14] When sciatica is caused by compression of a dorsal nerve root, it is considered a lumbar radiculopathy or radiculitis when accompanied by an inflammatory response.[15]

Extraspinal sciatica

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Illustration of fibrovascular bands restricting mobility of the sciatic nerve in multiple directions, like a splattering of glue

The sciatic nerve is highly mobile during hip and leg movements.[32][33] Any pathology which restricts normal movement of the sciatic nerve can put abnormal pressure, strain, or tension on the nerve in certain positions or during normal movements. For example, the presence of scar tissue around a nerve can cause traction neuropathy.[34]

A well known muscular cause of extraspinal sciatica is piriformis syndrome. The piriformis muscle is directly adjacent to the course of the sciatic nerve as it traverses through the intrapelvic space. Pathologies of the piriformis muscle such as injury (e.g. swelling and scarring), inflammation (release of cytokines affecting the local cellular environment), or space occupying lesions (e.g. tumor, cyst, hypertrophy) can affect the sciatic nerve.[27] Anatomic variations in nerve branching can also predispose the sciatic nerve to further compression by the piriformis muscle, such as if the sciatic nerve pierces the piriformis muscle.[35]

The sciatic nerve can also be entrapped outside of the pelvic space and this is called deep gluteal syndrome.[19] Surgical research has identified new causes of entrapment such as fibrovascular scar bands, vascular abnormalities, heterotropic ossification, gluteal muscles, hamstring muscles, and the gemelli-obturator internus complex.[20] In almost half of the endoscopic surgery cases, fibrovascular scar bands were found to be the cause of entrapment, impeding the movement of the sciatic nerve.[36][37]

Diagnosis

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Straight leg test sometimes used to help diagnose a lumbar herniated disc

Sciatica is typically diagnosed by physical examination, and the history of the symptoms.[4]

Physical tests

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Generally, if a person reports the typical radiating pain in one leg, as well as one or more neurological indications of nerve root tension or neurological deficit, sciatica can be diagnosed.[6]

The most frequently used diagnostic test is the straight leg raise to produce Lasègue's sign, which is considered positive if pain in the distribution of the sciatic nerve is reproduced with passive flexion of the straight leg between 30 and 70 degrees.[38] While this test is positive in about 90% of people with sciatica, approximately 75% of people with a positive test do not have sciatica.[4] Straight leg raising of the leg unaffected by sciatica may produce sciatica in the leg on the affected side; this is known as the Fajersztajn sign.[15] The presence of the Fajersztajn sign is a more specific finding for a herniated disc than Lasègue's sign.[15] Maneuvers that increase intraspinal pressure, such as coughing, flexion of the neck, and bilateral compression of the jugular veins, may transiently worsen sciatica pain.[15]

Medical imaging

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Imaging modalities such as computerised tomography or magnetic resonance imaging can help with the diagnosis of lumbar disc herniation.[39] Both are equally effective at diagnosing lumbar disk herniation, but computerized tomography has a higher radiation dose.[6] Radiography is not recommended because disks cannot be visualized by X-rays.[6] The utility of MR neurography in the diagnosis of piriformis syndrome is controversial.[16]

Discography could be considered to determine a specific disc's role in an individual's pain.[14] Discography involves the insertion of a needle into a disc to determine the pressure of disc space.[14] Radiocontrast is then injected into the disc space to assess for visual changes that may indicate an anatomic abnormality of the disc.[14] The reproduction of an individual's pain during discography is also diagnostic.[14]

Differential diagnosis

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Cancer should be suspected if there is previous history of it, unexplained weight loss, or unremitting pain.[13] Spinal epidural abscess is more common among those who have diabetes mellitus or immunodeficiency, or who have had spinal surgery, injection or catheter; it typically causes fever, leukocytosis and increased erythrocyte sedimentation rate.[13] If cancer or spinal epidural abscess is suspected, urgent magnetic resonance imaging is recommended for confirmation.[13] Proximal diabetic neuropathy typically affects middle aged and older people with well-controlled type-2 diabetes mellitus; onset is sudden, causing pain, usually in multiple dermatomes, quickly followed by weakness. Diagnosis typically involves electromyography and lumbar puncture.[13] Shingles is more common among the elderly and immunocompromised; typically, pain is followed by the appearance of a rash with small blisters along a single dermatome.[13][40] Acute Lyme radiculopathy may follow a history of outdoor activities during warmer months in likely tick habitats in the previous 1–12 weeks.[41] In the U.S., Lyme is most common in New England and Mid-Atlantic states and parts of Wisconsin and Minnesota, but it is expanding to other areas.[42][43] The first manifestation is usually an expanding rash possibly accompanied by flu-like symptoms.[44] Lyme can also cause a milder, chronic radiculopathy an average of 8 months after the acute illness.[13]

Management

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Sciatica can be managed with a number of different treatments[45] with the goal of restoring a person's normal functional status and quality of life.[14] When the cause of sciatica is lumbar disc herniation (90% of cases),[4] most cases resolve spontaneously over weeks to months.[46] Initially treatment in the first 6–8 weeks should be conservative.[4] More than 75% of sciatica cases are managed without surgery.[14] Smokers with sciatica are strongly urged to quit in order to promote healing.[14] Treatment of the underlying cause of nerve compression is needed in cases of epidural abscess, epidural tumors, and cauda equina syndrome.[14]

Physical activity

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Physical activity is often recommended for the conservative management of sciatica for persons who are physically able.[3] Bed rest is not recommended.[47] Although structured exercises provide small, short-term benefit for leg pain, in the long term no difference is seen between exercise or simply staying active.[48] The evidence for physical therapy in sciatica is unclear though such programs appear safe.[3] Physical therapy is commonly used.[3] Nerve mobilization techniques for sciatic nerve are supported by tentative evidence.[49]

Medication

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There is no one medication regimen used to treat sciatica.[45] Evidence supporting the use of opioids and muscle relaxants is poor.[50] Low-quality evidence indicates that NSAIDs do not appear to improve immediate pain, and all NSAIDs appear to be nearly equivalent in their ability to relieve sciatica.[50][51][52] Nevertheless, NSAIDs are commonly recommended as a first-line treatment for sciatica.[45] In those with sciatica due to piriformis syndrome, botulinum toxin injections may improve pain and function.[53] While there is little evidence supporting the use of epidural or systemic steroids,[54][55] systemic steroids may be offered to individuals with confirmed disc herniation if there is a contraindication to NSAID use.[45] Low-quality evidence supports the use of gabapentin for acute pain relief in those with chronic sciatica.[50] Anticonvulsants and biologics have not been shown to improve acute or chronic sciatica.[45] Antidepressants have demonstrated some efficacy in treating chronic sciatica, and may be offered to individuals who are not amenable to NSAIDs or who have failed NSAID therapy.[45]

Surgery

[edit]

If sciatica is caused by a herniated disc, the disc's partial or complete removal, known as a discectomy, has tentative evidence of benefit in the short term.[56] A modest reduction in pain is seen after 26 weeks, but not after one year (about 52 weeks).[47] If the cause is spondylolisthesis or spinal stenosis, surgery appears to provide pain relief for up to two years.[56]

For non-discogenic sciatica, the surgical treatment is typically a nerve decompression. A decompression seeks to remove tissue around the nerve that may be compressing it or restricting movement of the nerve.[57][58][59]

Alternative medicine

[edit]

Low to moderate-quality evidence suggests that spinal manipulation is an effective treatment for acute sciatica.[3][60] For chronic sciatica, the evidence supporting spinal manipulation as treatment is poor.[60] Spinal manipulation has been found generally safe for the treatment of disc-related pain; however, case reports have found an association with cauda equina syndrome,[61] and it is contraindicated when there are progressive neurological deficits.[62]

Prognosis

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About 39% to 50% of people with sciatica still have symptoms after one to four years.[63] In one study, around 20% were unable to work at their one-year followup, and 10% had surgery for the condition.[63]

Epidemiology

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Depending on how it is defined, less than 1% to 40% of people have sciatica at some point in time.[9][4] Sciatica is most common between the ages of 40 and 59, and men are more frequently affected than women.[2][3]

See also

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References

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  1. ^ a b c "Sciatica". Archived from the original on 7 March 2018. Retrieved 2 July 2015.
  2. ^ a b c d e f g h i j k l Institute for Quality and Efficiency in Health Care (October 9, 2014). "Slipped disk: Overview". Archived from the original on 8 September 2017. Retrieved 2 July 2015.
  3. ^ a b c d e f g h i j k l m n o p q r s t u v w Ropper, AH; Zafonte, RD (26 March 2015). "Sciatica". The New England Journal of Medicine. 372 (13): 1240–8. doi:10.1056/NEJMra1410151. PMID 25806916.
  4. ^ a b c d e f g h i j k l m n o p Valat, JP; Genevay, S; Marty, M; Rozenberg, S; Koes, B (April 2010). "Sciatica". Best Practice & Research. Clinical Rheumatology. 24 (2): 241–52. doi:10.1016/j.berh.2009.11.005. PMID 20227645.
  5. ^ T.J. Fowler; J.W. Scadding (28 November 2003). Clinical Neurology, 3Ed. CRC. p. 59. ISBN 978-0-340-80798-9.
  6. ^ a b c d e Koes BM, vanTulder, HW, Peul WC (2007). "Diagnosis and treatment of sciatica". The BMJ. 334 (7607): 1313. doi:10.1136/bmj.39223.428495.BE. PMC 1895638. PMID 17585160.
  7. ^ Markova, Tsvetio (2007). "Treatment of Acute Sciatica". Am Fam Physician. 75 (1): 99–100. PMID 17225710. Archived from the original on 2016-02-02.
  8. ^ Enke O, New HA, New CH, Mathieson S, McLachlan AJ, Latimer J, Maher CG, Lin CC (July 2018). "Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis". CMAJ. 190 (26): E786 – E793. doi:10.1503/cmaj.171333. PMC 6028270. PMID 29970367.
  9. ^ a b c d Cook CE, Taylor J, Wright A, Milosavljevic S, Goode A, Whitford M (June 2014). "Risk factors for first time incidence sciatica: a systematic review". Physiother Res Int. 19 (2): 65–78. doi:10.1002/pri.1572. PMID 24327326.
  10. ^ Simpson, John (2009). Oxford English dictionary (2nd ed.). Oxford: Oxford University Press. ISBN 978-0199563838.
  11. ^ Dioscorides, Materia Medica (2-184, s.v. Sinepi), p. 311
  12. ^ Bhat, Sriram (2013). SRB's Manual of Surgery. p. 364. ISBN 9789350259443.
  13. ^ a b c d e f g h i j k Tarulli AW, Raynor EM (May 2007). "Lumbosacral radiculopathy" (PDF). Neurologic Clinics. 25 (2): 387–405. doi:10.1016/j.ncl.2007.01.008. PMID 17445735. S2CID 15518713. Archived from the original (PDF) on 2019-02-20.
  14. ^ a b c d e f g h i j k l m n o Butterworth IV, John F. (2013). Morgan & Mikhail's Clinical Anesthesiology. David C. Mackey, John D. Wasnick (5th. ed.). New York: McGraw-Hill. pp. Chapter 47. Chronic Pain Management. ISBN 9780071627030. OCLC 829055521.
  15. ^ a b c d e f g h i j k l m Ropper, Allan H.; Samuels, Martin A.; Klein, Joshua P. (2014). "Chapter 11. Pain in the Back, Neck, and Extremities". Adams and Victor's Principles of Neurology (Tenth ed.). New York: McGraw-Hill Education Medical. ISBN 9780071794794. OCLC 857402060.
  16. ^ a b c Miller TA, White KP, Ross DC (September 2012). "The diagnosis and management of Piriformis Syndrome: myths and facts". Can J Neurol Sci. 39 (5): 577–83. doi:10.1017/s0317167100015298. PMID 22931697.
  17. ^ Kirschner JS, Foye PM, Cole JL (July 2009). "Piriformis syndrome, diagnosis and treatment". Muscle Nerve. 40 (1): 10–18. doi:10.1002/mus.21318. PMID 19466717. S2CID 19857216.
  18. ^ Lewis AM, Layzer R, Engstrom JW, Barbaro NM, Chin CT (October 2006). "Magnetic resonance neurography in extraspinal sciatica". Arch. Neurol. 63 (10): 1469–72. doi:10.1001/archneur.63.10.1469. PMID 17030664. S2CID 6634301.
  19. ^ a b Kizaki K, Uchida S, Shanmugaraj A, Aquino CC, Duong A, Simunovic N, Martin HD, Ayeni OR (October 2020). "Deep gluteal syndrome is defined as a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space: a systematic review". Knee Surg Sports Traumatol Arthrosc. 28 (10): 3354–3364. doi:10.1007/s00167-020-05966-x. PMID 32246173. S2CID 214784014.
  20. ^ a b c Martin HD, Reddy M, Gómez-Hoyos J (July 2015). "Deep gluteal syndrome". J Hip Preserv Surg. 2 (2): 99–107. doi:10.1093/jhps/hnv029. PMC 4718497. PMID 27011826.
  21. ^ a b Hernando MF, Cerezal L, Pérez-Carro L, Abascal F, Canga A (July 2015). "Deep gluteal syndrome: anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space". Skeletal Radiol. 44 (7): 919–34. doi:10.1007/s00256-015-2124-6. PMID 25739706.
  22. ^ Gandhi, Jason; Wilson, Anthony L; Liang, Raymond; Weissbart, Steven J; Khan, Sardar Ali (2020-11-11). "Sciatic endometriosis: A narrative review of an unusual neurogynecologic condition". Journal of Endometriosis and Pelvic Pain Disorders. 13 (1). SAGE Publications: 3–9. doi:10.1177/2284026520970813. ISSN 2284-0265. S2CID 228834273.
  23. ^ Sciatic Nerve Pain During Pregnancy: Causes and Treatment. American Pregnancy Association. Published September 20, 2017. Accessed November 12, 2018.
  24. ^ Ganko R, Rao PJ, Phan K, Mobbs RJ (May 2015). "Can bacterial infection by low virulent organisms be a plausible cause for symptomatic disc degeneration? A systematic review". Spine. 40 (10): E587–92. doi:10.1097/BRS.0000000000000832. PMID 25955094. S2CID 23436352.
  25. ^ Chen Z, Cao P, Zhou Z, Yuan Y, Jiao Y, Zheng Y (2016). "Overview: the role of Propionibacterium acnes in nonpyogenic intervertebral discs". Int Orthop (Review). 40 (6): 1291–8. doi:10.1007/s00264-016-3115-5. PMID 26820744. S2CID 889041.
  26. ^ Giuffre BA, Black AC, Jeanmonod R. Anatomy, Sciatic Nerve. [Updated 2023 May 4]. In: StatPearls [Internet]. Treasure Island (Florida): StatPearls Publishing; 2023 January. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482431/.
  27. ^ a b Davis D, Maini K, Vasudevan A. Sciatica. [Updated 2022 May 6]. In: StatPearls [Internet]. Treasure Island (Florida): StatPearls Publishing; 2023 January. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/.
  28. ^ Siddiq MAB, Clegg D, Hasan SA, Rasker JJ (October 2020). "Extra-spinal sciatica and sciatica mimics: a scoping review". Korean J Pain. 33 (4): 305–317. doi:10.3344/kjp.2020.33.4.305. PMC 7532296. PMID 32989195.
  29. ^ a b Parks, Edward (2017). Practical Office Orthopedics. [New York, N.Y.]: McGraw-Hill. pp. Chapter 6: Low Back Pain. ISBN 9781259642876. OCLC 986993775.
  30. ^ Halpern, Casey H. (2015). Schwartz's Principles of Surgery. Grady, M. Sean (Tenth ed.). [New York]: McGraw-Hill. pp. Chapter 42: Neurosurgery. ISBN 9780071800921. OCLC 892490454.
  31. ^ LeBlond, Richard F.; Brown, Donald D.; Suneja, Manish; Szot, Joseph F., eds. (2015). "Chapter 13: The Spine, Pelvis, and Extremities". DeGowin's Diagnostic Examination (Tenth ed.). New York: McGraw-Hill Education. ISBN 9780071814478. OCLC 876336892.
  32. ^ Martin HD, Khoury AN, Schroder R, Gomez-Hoyos J, Yeramaneni S, Reddy M, James Palmer I (July 2017). "The effects of hip abduction on sciatic nerve biomechanics during terminal hip flexion". J Hip Preserv Surg. 4 (2): 178–186. doi:10.1093/jhps/hnx008. PMC 5467418. PMID 28630740.
  33. ^ Alshami AM, Alshammari TK, AlMuhaish MI, Hegazi TM, Tamal M, Abdulla FA (June 2022). "Sciatic nerve excursion during neural mobilization with ankle movement using dynamic ultrasound imaging: a cross-sectional study". J Ultrasound. 25 (2): 241–249. doi:10.1007/s40477-021-00595-7. PMC 9148322. PMID 34036554.
  34. ^ Crosio A, Ronchi G, Fornasari BE, Odella S, Raimondo S, Tos P (April 2021). "Experimental Methods to Simulate and Evaluate Postsurgical Peripheral Nerve Scarring". J Clin Med. 10 (8): 1613. doi:10.3390/jcm10081613. PMC 8070420. PMID 33920209.
  35. ^ ROBINSON DR (March 1947). "Pyriformis syndrome in relation to sciatic pain". Am J Surg. 73 (3): 355–358. doi:10.1016/0002-9610(47)90345-0. PMID 20289074.
  36. ^ Martin HD, Shears SA, Johnson JC, Smathers AM, Palmer IJ (February 2011). "The endoscopic treatment of sciatic nerve entrapment/deep gluteal syndrome". Arthroscopy. 27 (2): 172–81. doi:10.1016/j.arthro.2010.07.008. PMID 21071168.
  37. ^ Park MS, Yoon SJ, Jung SY, Kim SH (May 2016). "Clinical results of endoscopic sciatic nerve decompression for deep gluteal syndrome: mean 2-year follow-up". BMC Musculoskelet Disord. 17: 218. doi:10.1186/s12891-016-1062-3. PMC 4875686. PMID 27206482.
  38. ^ Speed C (May 2004). "Low back pain". BMJ. 328 (7448): 1119–21. doi:10.1136/bmj.328.7448.1119. PMC 406328. PMID 15130982.
  39. ^ Gregory DS, Seto CK, Wortley GC, Shugart CM (October 2008). "Acute lumbar disk pain: navigating evaluation and treatment choices". Am Fam Physician. 78 (7): 835–42. PMID 18841731.
  40. ^ Dworkin RH, Johnson RW, Breuer J, et al. (2007). "Recommendations for the management of herpes zoster". Clin. Infect. Dis. 44 (Suppl 1): S1–26. doi:10.1086/510206. PMID 17143845. S2CID 10894629.
  41. ^ Shapiro ED (May 2014). "Clinical practice. Lyme disease" (PDF). The New England Journal of Medicine. 370 (18): 1724–1731. doi:10.1056/NEJMcp1314325. PMC 4487875. PMID 24785207. Archived from the original (PDF) on 19 October 2016.
  42. ^ "Lyme Disease Data and surveillance". Lyme Disease. Centers for Disease Control and Prevention. 2019-02-05. Retrieved April 12, 2019.
  43. ^ "Lyme Disease risk areas map". Risk of Lyme disease to Canadians. Government of Canada. 2015-01-27. Retrieved May 8, 2019.
  44. ^ Ogrinc K, Lusa L, Lotrič-Furlan S, Bogovič P, Stupica D, Cerar T, Ružić-Sabljić E, Strle F (Aug 2016). "Course and outcome of early European Lyme neuroborreliosis (Bannwarth syndrome): clinical and laboratory findings". Clinical Infectious Diseases. 63 (3): 346–53. doi:10.1093/cid/ciw299. PMID 27161773.
  45. ^ a b c d e f Lewis RA, Williams NH, Sutton AJ, Burton K, Din NU, Matar HE, Hendry M, Phillips CJ, Nafees S, Fitzsimmons D, Rickard I, Wilkinson C (June 2015). "Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses" (PDF). Spine J. 15 (6): 1461–77. doi:10.1016/j.spinee.2013.08.049. PMID 24412033.
  46. ^ Casey E (February 2011). "Natural history of radiculopathy". Phys Med Rehabil Clin N Am. 22 (1): 1–5. doi:10.1016/j.pmr.2010.10.001. PMID 21292142.
  47. ^ a b Ostelo RW (2020). "Physiotherapy management of sciatica". Journal of Physiotherapy. 66 (2): 83–88. doi:10.1016/j.jphys.2020.03.005. PMID 32291226.
  48. ^ Fernandez M, Hartvigsen J, Ferreira PH (2015). "Advice to Stay Active or Structured Exercise in the Management of Sciatica: A Systematic Review and Meta-analysis". Spine. 40 (10): 1457–1466. doi:10.1097/BRS.0000000000001036. PMID 26165218.
  49. ^ Basson, Annalie; Olivier, Benita; Ellis, Richard; Coppieters, Michel; Stewart, Aimee; Mudzi, Witness (2017-08-31). "The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Meta-analysis". Journal of Orthopaedic & Sports Physical Therapy. 47 (9): 593–615. doi:10.2519/jospt.2017.7117. hdl:1871.1/c965ed2a-c397-403f-8790-275a4cb9fbde. PMID 28704626. S2CID 3421251. The majority of studies had a high risk of bias
  50. ^ a b c Pinto RZ, Maher CG, Ferreira ML, Ferreira PH, Hancock M, Oliveira VC, et al. (February 2012). "Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis". BMJ. 344: e497. doi:10.1136/bmj.e497. PMC 3278391. PMID 22331277.
  51. ^ Machado GC, Maher CG, Ferreira PH, Day RO, Pinheiro MB, Ferreira ML (July 2017). "Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis". Ann. Rheum. Dis. 76 (7): 1269–1278. doi:10.1136/annrheumdis-2016-210597. PMID 28153830. S2CID 22850331.
  52. ^ Rasmussen-Barr E, Held U, Grooten WJ, Roelofs PD, Koes BW, van Tulder MW, Wertli MM (October 2016). "Non-steroidal anti-inflammatory drugs for sciatica". Cochrane Database Syst Rev. 10 (2): CD012382. doi:10.1002/14651858.CD012382. PMC 6461200. PMID 27743405.
  53. ^ Waseem Z, Boulias C, Gordon A, Ismail F, Sheean G, Furlan AD (January 2011). "Botulinum toxin injections for low-back pain and sciatica". Cochrane Database Syst Rev (1): CD008257. doi:10.1002/14651858.CD008257.pub2. PMID 21249702.
  54. ^ Balagué F, Piguet V, Dudler J (2012). "Steroids for LBP – from rationale to inconvenient truth". Swiss Med Wkly. 142: w13566. doi:10.4414/smw.2012.13566. PMID 22495738.
  55. ^ Chou R, Hashimoto R, Friedly J, Fu R, Bougatsos C, Dana T, Sullivan SD, Jarvik J (September 2015). "Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis". Ann. Intern. Med. 163 (5): 373–81. doi:10.7326/M15-0934. PMID 26302454. S2CID 25696028.
  56. ^ a b Fernandez M, Ferreira ML, Refshauge KM, Hartvigsen J, Silva IR, Maher CG, Koes BW, Ferreira PH (November 2016). "Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis". Eur Spine J. 25 (11): 3495–3512. doi:10.1007/s00586-015-4148-y. PMID 26210309. S2CID 4450957.
  57. ^ Metikala S, Sharma V (March 2022). "Endoscopic Sciatic Neurolysis for Deep Gluteal Syndrome: A Systematic Review". Cureus. 14 (3): e23153. doi:10.7759/cureus.23153. PMC 9010003. PMID 35444897.
  58. ^ Kay J, de Sa D, Morrison L, Fejtek E, Simunovic N, Martin HD, Ayeni OR (December 2017). "Surgical Management of Deep Gluteal Syndrome Causing Sciatic Nerve Entrapment: A Systematic Review". Arthroscopy. 33 (12): 2263–2278.e1. doi:10.1016/j.arthro.2017.06.041. PMID 28866346.
  59. ^ Lemos N, Sermer C, Fernandes G, Morgado-Ribeiro A, Rossos A, Zhao ZY, Girão MJ, Peng P (May 2021). "Laparoscopic approach to refractory extraspinal sciatica and pudendal pain caused by intrapelvic nerve entrapment". Sci Rep. 11 (1): 10820. Bibcode:2021NatSR..1110820L. doi:10.1038/s41598-021-90319-y. PMC 8144185. PMID 34031480.
  60. ^ a b Leininger B, Bronfort G, Evans R, Reiter T (February 2011). "Spinal manipulation or mobilization for radiculopathy: a systematic review". Physical Medicine and Rehabilitation Clinics of North America. 22 (1): 105–25. doi:10.1016/j.pmr.2010.11.002. PMID 21292148.
  61. ^ Tamburrelli FC, Genitiempo M, Logroscino CA (May 2011). "Cauda equina syndrome and spine manipulation: case report and review of the literature". Eur Spine J. 20 (Suppl 1): S128–31. doi:10.1007/s00586-011-1745-2. PMC 3087049. PMID 21404036.
  62. ^ WHO guidelines on basic training and safety in chiropractic. "2.1 Absolute contraindications to spinal manipulative therapy", p. 21. Archived 2008-02-27 at the Wayback Machine WHO
  63. ^ a b Wilkinson, C.; Chakraverty, R.; Rickard, I.; Hendry, M.; Nafees, S.; Burton, K.; Sutton, A.; Jones, M.; Phillips, C. (November 2011). Background. NIHR Journals Library.
[edit]
  • "Sciatica". MedlinePlus. U.S. National Library of Medicine.

 

Cauda equina syndrome
The cauda equina is the "horse tail" of nerves that branch off after the conus medullaris
Specialty Neurosurgery, orthopedics
Symptoms Low back pain, pain that radiates down the leg, numbness around the anus, loss of bowel or bladder control[1]
Usual onset Rapid or gradual[1]
Causes Disc herniation, spinal stenosis, cancer, trauma, epidural abscess, epidural hematoma[1][2]
Diagnostic method Medical imaging (MRI, CT scan)[1][3]
Treatment Surgery (laminectomy)[1]
Prognosis 20% risk of poor outcome
Frequency 1 in 500,000 a year

Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged.[2] Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control.[1] Onset may be rapid or gradual.[1]

The cause is usually a disc herniation in the lower region of the back.[1] Other causes include spinal stenosis, cancer, trauma, epidural abscess, and epidural hematoma.[1][2] The diagnosis is suspected based on symptoms and confirmed by medical imaging such as MRI or CT scan.[1][3]

CES is generally treated surgically via laminectomy.[1] Sudden onset is regarded as a medical emergency requiring prompt surgical decompression, with delay causing permanent loss of function.[4] Permanent bladder problems, sexual dysfunction or numbness may occur despite surgery.[1][3] A poor outcome occurs in about 20% of people despite treatment.[1] About 1 in 70,000 people is affected every year.[1] It was first described in 1934.[5]

Signs and symptoms

[edit]
Approximate area of "saddle anesthesia" seen from behind (yellow highlight)

Signs and symptoms of cauda equina syndrome include:

Severe back pain, saddle anesthesia, urinary or fecal incontinence and sexual dysfunction are considered "red flags", i.e. features which require urgent investigation.[8]

Causes

[edit]

After the conus medullaris (near lumbar vertebral levels 1 (L1) and 2 (L2), occasionally lower), the spinal canal contains a bundle of nerve fibers (the cauda equina or "horse-tail") that branches off the lower end of the spinal cord and contains the nerve roots from L1–L5 and S1–S5. The nerve roots from L4–S4 join in the sacral plexus which affects the sciatic nerve, which travels caudally (toward the feet). Compression, trauma or other damage to this region of the spinal canal can result in cauda equina syndrome.[citation needed]

The symptoms may also appear as a temporary side-effect of a sacral extra-dural injection.[9]

Trauma

[edit]

Direct trauma can also cause cauda equina syndrome. Most common causes include as a complication of lumbar punctures, burst fractures resulting in posterior migration of fragments of the vertebral body, severe disc herniations, spinal anaesthesia involving trauma from catheters and high local anaesthetic concentrations around the cauda equina, penetrating trauma such as knife wounds or ballistic trauma.[10] Cauda equina syndrome may also be caused by blunt trauma suffered in an event such as a car accident or fall.[11]

Spinal stenosis

[edit]

CES can be caused by lumbar spinal stenosis, which is when the diameter of the spinal canal narrows. This could be the result of a degenerative process of the spine (such as osteoarthritis) or a developmental defect which is present at birth. In the most severe cases of spondylolisthesis cauda equina syndrome can result.[10]

Inflammatory conditions

[edit]

Chronic spinal inflammatory conditions such as Paget disease, neurosarcoidosis, chronic inflammatory demyelinating polyneuropathy, ankylosing spondylitis, rheumatoid disease of the spine, and chronic tuberculosis can cause it. This is due to the spinal canal narrowing that these kinds of syndromes can produce.[10]

Risk factors

[edit]

Individuals most at risk for disc herniation are the most likely to develop CES. Race has little influence with the notable exception that African Americans appear slightly less likely to develop CES than other groups.[12][13][14] Middle age also appears to be a notable risk factor, as those populations are more likely to develop a herniated disc; heavy lifting can also be inferred as a risk factor for CES.[12][14]

Other risk factors include obesity and being female.[15]

Diagnosis

[edit]
MRI of an abscess causing cauda equina syndrome

Diagnosis is first suspected clinically based on history and physical exam and usually confirmed by an MRI scan or CT scan, depending on availability.[4] Bladder scanning and loss of catheter sensation can also be used to evaluate bladder dysfunction in suspected cases of cauda equina syndrome and can aid diagnosis before MRI scanning.[citation needed] Early surgery in acute onset of severe cases has been reported to be important.[4]

Prevention

[edit]

Early diagnosis of cauda equina syndrome can allow for preventive treatment. Signs that allow early diagnosis include changes in bowel and bladder function and loss of feeling in groin.[16] Changes in sensation can start as pins and needles leading to numbness. Changes in bladder function may be changes to stream or inability to fully empty the bladder. If a person progresses to full retention intervention is less likely to be successful.[citation needed]

Management

[edit]

The management of true cauda equina syndrome frequently involves surgical decompression. When cauda equina syndrome is caused by a herniated disk early surgical decompression is recommended.[17]

Sudden onset cauda equina syndrome is regarded as a medical/surgical emergency.[4] Surgical decompression by means of laminectomy or other approaches may be undertaken within 6,[18] 24[19] or 48 hours of symptoms developing if a compressive lesion (e.g., ruptured disc, epidural abscess, tumor or hematoma) is demonstrated. Early treatment may significantly improve the chance of avoiding long-term neurological damage.[17][19]

Surgery may be required to remove blood, bone fragments, a tumor or tumors, a herniated disc or an abnormal bone growth. If the tumor cannot be removed surgically and is malignant then radiotherapy may be used as an alternative to relieve pressure. Chemotherapy can also be used for spinal neoplasms. If the syndrome is due to an inflammatory condition e.g., ankylosing spondylitis, anti-inflammatory, including steroids can be used as an effective treatment. If a bacterial infection is the cause then an appropriate course of antibiotics can be used to treat it.[20]

Cauda equina syndrome can occur during pregnancy due to lumbar disc herniation. The risk of cauda equina syndrome during pregnancy increases with age of the mother. Surgery can still be performed and pregnancy does not adversely affect treatment. Treatment for those with cauda equina can and should be carried out at any time during pregnancy.[21]

Lifestyle issues may need to be addressed post-treatment. Issues could include the person's need for physiotherapy and occupational therapy due to lower limb dysfunction. Obesity might also need to be tackled.[20]

Bowel and bladder control

[edit]

Rehabilitation of CES depends on the severity of the injury. If permanent damage occurs, then impairment in bladder and bowel control may result.[22] Once surgery is performed, resting is required until the bladder and bowel dysfunction can be assessed. Urinary catheterization may help with bladder control. Gravity and exercise can help control bowel movement (Hodges, 2004). Pelvic floor exercises assist in controlling bowel movements (Pelvic Floor Exercises, 2010).[full citation needed] These exercises can be done standing, lying, or on all fours with the knees slightly separated. Full recovery of bowel and bladder control can take as long as two years.[citation needed]

Prognosis

[edit]

The prognosis for complete recovery is dependent upon many factors. The most important of these is the severity and duration of compression upon the damaged nerve(s). Generally, the longer the time before intervention to remove the compression causing nerve damage, the greater the damage caused to the nerve(s).[citation needed]

Damage can be so severe that nerve regrowth is impossible, and the nerve damage will be permanent. In cases where the nerve has been damaged but is still capable of regrowth, recovery time is widely variable. Surgical intervention with decompression of the cauda equina can assist recovery. Delayed or severe nerve damage can mean up to several years' recovery time because nerve growth is exceptionally slow.[citation needed]

Review of the literature indicates that around 50–70% of patients have urinary retention (CES-R) on presentation with 30–50% having an incomplete syndrome (CES-I). The latter group, especially if the history is less than a few days, usually requires emergency MRI to confirm the diagnosis followed by prompt decompression. CES-I with its more favourable prognosis may become CES-R at a later stage.[23]

Epidemiology

[edit]
The nerve roots extending from the lumbar spine are susceptible to compression, leading to CES. Intervertebral discs can be dislocated to different degrees, contributing to such compression.

Various etiologies of CES include fractures, abscesses, hematomas, and any compression of the relevant nerve roots.[24] Injuries to the thoracolumbar spine will not necessarily result in a clinical diagnosis of CES, but in all such cases it is necessary to consider. Few epidemiological studies of CES have been done in the United States, owing to difficulties such as amassing sufficient cases as well as defining the affected population, therefore this is an area deserving of additional scrutiny.[12]

Traumatic spinal cord injuries occur in approximately 40 people per million annually in the United States, resulting from traumas due to motor vehicle accidents, sporting injuries, falls, and other factors.[13] An estimated 10 to 25% of vertebral fractures will result in injury to the spinal cord.[13] Thorough physical examinations are required, as 5 to 15% of trauma patients have fractures that initially go undiagnosed.[25]

The most frequent injuries of the thoracolumbar region are to the conus medullaris and the cauda equina, particularly between T12 and L2.[13] Of these two syndromes, CES is the more common.[13] CES mainly affects middle-aged individuals, particularly those in their forties and fifties, and presents more often in men.[13][14][26] It is not a typical diagnosis, developing in only 4 to 7 out of every 10,000 to 100,000 patients, and is more likely to occur proximally.[12][13][14] Disc herniation is reportedly the most common cause of CES, and it is thought that 1 to 2% of all surgical disc herniation cases result in CES.[12][13]

CES affects mainly middle-aged individuals. There is a significant cost associated with hospital admissions, as CES is considered an emergent condition.

CES is often concurrent with congenital or degenerative diseases and represents a high cost of care to those admitted to the hospital for surgery.[13][26] Hospital stays generally last 4 to 5 days, and cost an average of $100,000 to $150,000.[26] Delays in care for cauda equina results in the English NHS paying about £23 million a year in compensation.[27]

 

In animals

[edit]

Degenerative lumbosacral stenosis (DLSS), also known as cauda equina syndrome, is a pathologic degeneration in the lumbosacral disk in dogs. DLSS affects the articulation, nerve progression, and tissue and joint connections of the disk.[28][29] This degeneration causes compressions in soft tissues and nerve root locations in the caudal area of the medulla, causing neuropathic pain in the lumbar vertebrae.[30][31]

References

[edit]
  1. ^ a b c d e f g h i j k l m n Gardner A, Gardner E, Morley T (May 2011). "Cauda equina syndrome: a review of the current clinical and medico-legal position". European Spine Journal. 20 (5): 690–7. doi:10.1007/s00586-010-1668-3. PMC 3082683. PMID 21193933.
  2. ^ a b c "Cauda equina syndrome". Genetic and Rare Diseases Information Center (GARD). 2015. Archived from the original on February 3, 2017. Retrieved 9 November 2017.
  3. ^ a b c "Cauda Equina Syndrome-OrthoInfo – AAOS". orthoinfo.aaos.org. March 2014. Retrieved 9 November 2017.
  4. ^ a b c d Shapiro S (February 2000). "Medical realities of cauda equina syndrome secondary to lumbar disc herniation". Spine. 25 (3): 348–51, discussion 352. doi:10.1097/00007632-200002010-00015. PMID 10703108. S2CID 44975909.
  5. ^ Chau AM, Xu LL, Pelzer NR, Gragnaniello C (2014). "Timing of surgical intervention in cauda equina syndrome: a systematic critical review". World Neurosurgery. 81 (3–4): 640–50. doi:10.1016/j.wneu.2013.11.007. PMID 24240024.
  6. ^ Larner AJ (2006). A Dictionary of Neurological Signs (2nd ed.). [New York]: Springer Science+Business Media, Inc. ISBN 9780387262147.
  7. ^ a b Kraemer (2009). Intervertebral disk diseases causes, diagnosis, treatment, and prophylaxis (3rd ed.). Stuttgart: Thieme. ISBN 9783131495617.
  8. ^ Gardner A, Gardner E, Morley T (May 2011). "Cauda equina syndrome: a review of the current clinical and medico-legal position". European Spine Journal. 20 (5): 690–7. doi:10.1007/s00586-010-1668-3. PMC 3082683. PMID 21193933.
  9. ^ Gerald L Burke, MD. "Backache from Occiput to Coccyx". Archived from the original on 2017-08-17. Retrieved 2014-07-23.
  10. ^ a b c Eck JC (11 May 2007). "Cauda Equina Syndrome Causes". Cauda Equina Syndrome. WebMD. Retrieved 25 April 2009.
  11. ^ Brian (2021-10-12). "What Is Cauda Equina Syndrome?". Retrieved 2023-01-05.
  12. ^ a b c d e Schoenfeld AJ, Bader JO (September 2012). "Cauda equina syndrome: an analysis of incidence rates and risk factors among a closed North American military population". Clinical Neurology and Neurosurgery. 114 (7): 947–50. doi:10.1016/j.clineuro.2012.02.012. PMID 22402198. S2CID 2629460.
  13. ^ a b c d e f g h i Radcliff KE, Kepler CK, Delasotta LA, Rihn JA, Harrop JS, Hilibrand AS, et al. (September 2011). "Current management review of thoracolumbar cord syndromes". The Spine Journal. 11 (9): 884–92. doi:10.1016/j.spinee.2011.07.022. PMID 21889419.
  14. ^ a b c d Small SA, Perron AD, Brady WJ (March 2005). "Orthopedic pitfalls: cauda equina syndrome". The American Journal of Emergency Medicine. 23 (2): 159–63. doi:10.1016/j.ajem.2004.03.006. PMID 15765336.
  15. ^ Long B, Koyfman A, Gottlieb M (January 2020). "Evaluation and management of cauda equina syndrome in the emergency department". The American Journal of Emergency Medicine. 38 (1): 143–148. doi:10.1016/j.ajem.2019.158402. PMID 31471075.
  16. ^ Eck JC (11 May 2007). "Prevention". Cauda Equina Syndrome. WebMD. Retrieved 25 April 2009.
  17. ^ a b Ahn UM, Ahn NU, Buchowski JM, Garrett ES, Sieber AN, Kostuik JP (June 2000). "Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes". Spine. 25 (12): 1515–22. doi:10.1097/00007632-200006150-00010. PMID 10851100. S2CID 46674147.
  18. ^ "Neurosurgery for Cauda Equina Syndrome". Medscape. November 11, 2013. Retrieved 18 March 2015.
  19. ^ a b "Delayed presentation of cauda equina syndrome secondary to lumbar disc herniation: functional outcomes and health-related quality of life". Canadian Association of Emergency Physicians. July 10, 2001. Archived from the original on 21 March 2015. Retrieved 18 March 2015.
  20. ^ a b Tidy C (16 Nov 2009). "Cauda Equina Syndrome". Egton Medical Information Systems. Archived from the original on 23 January 2010. Retrieved 11 January 2010.
  21. ^ Brown MD, Levi AD (February 2001). "Surgery for lumbar disc herniation during pregnancy". Spine. 26 (4): 440–3. doi:10.1097/00007632-200102150-00022. PMID 11224893. S2CID 31698755.
  22. ^ "Cauda Equina". Cauda equina - Bladder and Bowel Community. Bladder and Bowel Support Company Limited. Archived from the original on 16 January 2017. Retrieved 15 January 2017.
  23. ^ Gardner A, Gardner E, Morley T (May 2011). "Cauda equina syndrome: a review of the current clinical and medico-legal position". European Spine Journal. 20 (5): 690–7. doi:10.1007/s00586-010-1668-3. PMC 3082683. PMID 21193933.
  24. ^ Gitelman A, Hishmeh S, Morelli BN, Joseph SA, Casden A, Kuflik P, et al. (November 2008). "Cauda equina syndrome: a comprehensive review". American Journal of Orthopedics. 37 (11): 556–62. PMID 19104682.
  25. ^ Harrop JS, Hunt GE, Vaccaro AR (June 2004). "Conus medullaris and cauda equina syndrome as a result of traumatic injuries: management principles". Neurosurgical Focus. 16 (6): e4. doi:10.3171/foc.2004.16.6.4. PMID 15202874.
  26. ^ a b c "National and regional estimates on hospital use for all patients from the HCUP nationwide inpatient sample (NIS)". United States Department of Health and Human Services Agency for Healthcare Research. 2012. Archived from the original on 2015-03-01. Retrieved 2013-05-23.
  27. ^ "Delayed spinal surgery costs £23m in compensation". Health Service Journal. 30 January 2019. Retrieved 5 March 2019.
  28. ^ Danielsson F, Sjöström L (1999). "Surgical treatment of degenerative lumbosacral stenosis in dogs". Veterinary Surgery. 28 (2): 91–8. doi:10.1053/jvet.1999.0091. PMID 10100762.
  29. ^ Jeffery ND, Barker A, Harcourt-Brown T (July 2014). "What progress has been made in the understanding and treatment of degenerative lumbosacral stenosis in dogs during the past 30 years?". Veterinary Journal. 201 (1): 9–14. doi:10.1016/j.tvjl.2014.04.018. PMID 24878265.
  30. ^ Giudice E, Crinò C, Barillaro G, Crupi R, Macrì F, Viganò F, Di Pietro S (2019-09-01). "Clinical findings in degenerative lumbosacral stenosis in ten dogs—A pilot study on the analgesic activity of tramadol and gabapentin". Journal of Veterinary Behavior. 33: 7–15. doi:10.1016/j.jveb.2019.05.004. ISSN 1558-7878. S2CID 181851509.
  31. ^ Meij BP, Bergknut N (September 2010). "Degenerative lumbosacral stenosis in dogs". The Veterinary Clinics of North America. Small Animal Practice. 40 (5): 983–1009. doi:10.1016/j.cvsm.2010.05.006. PMID 20732601.
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