Localization

Lumboischialgia is always caused by irritation of the sciatic nerve. In the majority of cases, the pain that is passed on to the leg occurs either on the left or right side. The physique is often asymmetrical due to certain influences and also in the spinal column the structures on the right and left are different.

It is therefore dependent on various influences and coincidences whether the lumboischialgia occurs on the left or right side. In the most common cause of lumboischialgia, the intervertebral disc between the vertebral bodies bulges in a certain direction. The direction also depends on the type of load and pressure.

Consequently, the intervertebral disc presses in a certain direction and onto a sciatic nerve. It is very unlikely that both sciatic nerves are equally affected. The sciatic nerve for each leg to be treated emerges from the vertebral bodies on the left and right sides.

A bilateral lumboischialgia is very rare. However, if it does occur, it is only rarely equally pronounced. It is highly probable that a herniated disc is not the cause of bilateral lumboischialgia.

Arthrotic and bony changes in the vertebral bodies are more likely. Narrowing of the spinal canal may also be a possible cause of bilateral lumboischialgia. Here, the nerve is already compressed before it exits the spinal column.

Finally, a fracture of a vertebral body is also a rare, potential cause of the secondary lumbar pain. A central fracture in the vertebra can damage the exiting nerves on both sides. However, since each leg has its own independent sciatic nerve, the overall probability of an even bilateral symptomatology is very low.

Representation of a mobile segment with two adjacent vertebral bodies and the exiting spinal nerves.

Vertebral body
Intervertebral disc
Nerve Root
Anterior spinal cord nerve branch (ramus ventralis)
Rear spinal cord nerve branch (ramus dorsalis)
Facet joint – vertebral joint
Union of the spinal cord nerves to the body nerves (e.g. sciatic nerve)

The symptoms described by the patient and the physical examination are indicative of whether lumboischialgia is present and whether it requires further diagnostic measures. A characteristic examination feature in lumboischialgia is the Lasegue sign (Lasegue test).

For this test, the patient is in a supine position. The painful leg is then slowly lifted by the physician in an extended position with flexion in the hip joint. The patient should not do anything during this process, i.e. be as relaxed as possible.

If the symptoms of root irritation are present, the patient will notice an early increase in pain in his lumboischialgia. The background to this is the stretching of the sciatic nerve due to the lifting of the leg, which in turn is transferred to the irritated nerve root. The Lasegue test is then considered positive.

If the physician wants to increase the extension of the sciatic nerve, he pulls the tip of the lifted leg towards the patient. The lumboischialgia continues to accentuate (Bragard test: positive). The Lasegue sign is only positive in the case of a characteristic lumboischialgiform pain indication when the leg is lifted up to approx.

45°. If pain only occurs when the leg is lifted above this angle, the Lasegue test can no longer be defined as positive, because some of the other diseases mentioned above can also lead to such a symptom and it is therefore no longer certain that the leg pain is caused by a spinal nerve root. In this case the Lasegue test is negative.

Sometimes such a test result is also called a positive “pseudo-Lasegue” test. If the root pain is to be proven in imaging procedures, magnetic resonance imaging (MRI of the lumbar spine) is the most suitable method. It can be used to visualize the nerve roots of the spinal cord and possibly herniated discs.

For the symptomatic treatment of lumboischialgia, a variety of different therapeutic approaches are suitable. Symptomatic therapy is understood to be a therapy based on signs of disease (symptoms). A truly causal therapy, such as the removal of a herniated disc, does not take place initially.

The lower back (lumbar spine) is relieved by a step positioning and the nervus sciaticus is relaxed by the bent legs. The aim of physiotherapy in acute lumboischialgia is to calm the mechanically irritated nerve root. A suitable method for this is, for example, sling table treatment, in which the patient is placed in a weightless position and the nerve exit holes (neuroforamas) dilate.

The nerve root, which is under pressure in the area of the nerve exit holes, is thus given the opportunity to recover. General information on physiotherapy can also be found under our topic: Physiotherapy The use of therapeutically effective forms of current (electrotherapy, electrostimulation) belongs to the field of physical therapy and is issued with the Ordinance on Therapeutic Products for Physiotherapy. Different types of current have anti-inflammatory and pain-relieving effects.

MedicationClassical medications used to inhibit inflammation and pain are non-steroidal anti-inflammatory drugs (NSAIDs) and cortisone. Application in tablet form or as cortisone injection is possible. The main aim is to reduce pain by inhibiting inflammation at the nerve root.

Pregabalin (Lyrika ®) can also be used as a concomitant therapy for chronic lumboischialgia. Lyrica ® has an analgesic effect in neuropathic pain (nerve pain) of various types. Information about the drug Berlosin from our partner.

The most effective therapy for lumboischialgia is local, targeted infiltration of the affected nerve roots. This form of injection therapy is also known as periradicular therapy (PRT). In order to apply infiltrations precisely to the nerve roots, an imaging procedure is necessary.

Especially suitable for this is the imaging support of computer tomography (CT). A mixture of a local anesthetic and cortisone is usually used as the injection content. Infiltrations close to the spinal cord such as epidural infiltration or sacral infiltration (sacral blockage, sacral flooding) are also used with great success.Due to possible side effects, such as a short-term feeling of weakness in the legs and a resulting risk of falling, these infiltrations are preferably performed under stationary control.

In the primary therapy of lumboischialgia, the administration of cortisone does not play a role. In the ideal case, the therapy consists of a combination of pain therapy with medication and physiotherapy. However, if the pain does not diminish as a result, further therapy methods must be considered.

Physical therapy is an important form of therapy in this context. Electrotherapy or the administration of cortisone can initially relieve the pain and stop inflammation. Cortisone has strong anti-inflammatory effects.

A further therapy option that can be used after the failure of other therapies is a local injection of cortisone and anaesthetics at the nerve root that causes the radiating pain. Under close observation in CT, the mixture is injected into the nerve root and thus numbs it. It is not a causal therapy, but only a symptomatic therapy, but achieves good results.

If lumboischialgia cannot be treated sufficiently conservatively due to the severity of the underlying disease, e.g. due to a very large herniated disc, surgical therapy measures are applied by removing the herniated disc (microdiscectomy, endoscopic discectomy) and/or widening the nerve exit holes (decompression, foraminotomy). Kinesiotapes, in contrast to conventional rigid tape dressings, are elastic tapes that are applied to the skin from the outside. The elastic bandages have no influence on the movement in the joint.

Due to the light, external pulling effect, however, they allow movements to become more conscious. As a result, more conscious, less jerky and gentler movements should be performed. The Kinesiotape is used for the therapy of muscle complaints but also for prevention in sports medicine.

Kinesiotape can also promote more conscious movements in the lower back and prevent disc problems if necessary. Acupuncture is an alternative medical treatment approach from traditional Chinese medicine. Here, disturbances in the balance of the body are corrected with pinpricks.

The needles are inserted by an experienced therapist on so-called “meridians” of the body to correct the imbalance. Acupuncture is used especially in orthopedics and thus also in the treatment of chronic back pain and lumboischialgia with radiation into the legs. The exact effect of acupuncture is controversial.

Many treated patients describe a subjective improvement of their symptoms. However, it is important to first weigh up a drug or surgical therapy for acute causes such as a herniated disc. Acupuncture can then be used as a complementary therapy concept.