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SciaticaAka: Sciatic Pain, Lumbar Radiculopathy

Definition
1. Pain originating in low back
2. Radiates into posterior or lateral thigh
Efficacy: Sciatica as a predictor for Lumbar Disc Disease
1. Overall
  1. Only 4% of Sciatica is Lumbar Disc Disease
  2. Patients with symptomatic Lumbar Disc Herniation have Sciatica in 99% of cases
2. Findings that increase Specificity of Sciatica for Lumbar Disc Disease
  1. Pain worse in the leg than the back
  2. Pain or numbness follows a typical dermatomal pattern
  3. Pain worse with valsalva maneuver (e.g. coughing or sneezing)
3. Findings suggesting diagnosis other than Lumbar Disc Herniation
  1. See Low Back Pain Red Flags
Differential Diagnosis: Sciatica
1. Spinal problems
  1. Lumbar Disc Herniation (most common cause)
  2. Facet arthropathy
  3. Spinal tumors
  4. Pseudoclaudication or Lumbar Spinal Stenosis
  5. Vertebral Fracture
  6. Disciitis
2. Musculoskeletal problems external to the spine
  1. Greater Trochanteric Bursitis
  2. Iliotibial Band Syndrome
  3. Meralgia Paresthetica
  4. Piriformis Syndrome
  5. Sacroiliitis

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This page was written by Scott Moses, MD. This page was last revised on 11/4/2008 9:35:28 PM. This page was last published on 8/14/2009. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.