Diagnosis of lumbar sciatica

introduction

If there is pain in the lower back, this is especially the case anamnese and clinical examination groundbreaking for the correct diagnosis of lumbar sciatica. The precise description the pain is especially important. Above all, the Onset of pain, the severity of the pain and other symptoms are described in detail. If the pain occurred for the first time during heavy lifting work, this indicates pain from a person Herniated disc of the lumbar spine down.

Is the pain slowly increasing, or has been present subliminally for a long time, this may be more indicative of an inflammatory or tumorous Be origin. If the pain radiates to the legs, or other symptoms such as paralysis, Paresthesia or one Incontinence occur, this is a clear indication of a nervous cause in the area of ​​the Vertebral canal and requires quick clarification and, if necessary, one rapid operational care.

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Clinical diagnosis of lumbar sciatica

In addition, the previous medical history the orientation of lumbar sciatica. In the case of a previously known tumor, are Bone metastases possible. Is an earlier Herniated disc in the lumbar spine area occurred, there is a greater risk of another herniated disc. As part of the clinical examination of lumbar sciatica, the back is opened muscular tension or Tenderness examined. This would be an indication of a muscular problem and does not have to be treated surgically.

Furthermore serve neurological examinations the more precise finding of the diagnosis of lumbar sciatica. Especially the Leg reflexes checked. If the Partellar tendon reflex (PSR) or des Achilles tendon reflexes (ASR) there is a suspicion of a herniated disc with compression and thus failure of the affected nerve. Also Differences in sensitivity to the Legs and in Area of ​​the buttocks are indicative of a nerve injury.

This is a clinical test of lumbar sciatica positive Lasègue sign. Here the patient becomes flat on your back and then passively bent the extended leg in the hip joint by the examiner. Step here at one Flexion <70 ° pain in the back which suddenly shoot in and radiate into the leg in question, the test is positive. In this case, it is a clear indication of a herniated disc of the lumbar spine in segments L4 / 5 and L5 / S1.

Diagnosis through laboratory values

Indications of a possible cause can also be found in the laboratory. Very high inflammatory parameters are an indication of an inflammatory process in the body and can possibly be associated with the Back pain related. Changes in the blood count combined with weight loss and pain may indicate a malignant process. Is there any suspicion of a Meningitis or Cancer cells in the liquor spaceso becomes a CSF puncture carried out. Corresponding cells, which can be the cause of back pain, also show up here. However, if back pain occurs suddenly, tumor or inflammatory causes are rare.

Imaging procedures

For this reason, in addition to the anamnesis, the imaging diagnostics of the lumbar spine plays a very important role. For imaging diagnostics you can

• Ultrasonic
• X-ray image
• Computed Tomography (CT)
  or.
• Magnetic resonance imaging of the lumbar spine (MRI) can be used.

The Ultrasound examination (Sonography) is used to assess soft tissues and can cause inflammation, a edema (Water retention), one abscess or show changes in the muscles. If these changes are visible, a herniated disc may be excluded. However, the ultrasound examination is used for diagnosis only suitable in exceptional cases.

To bony changes like an osteophyte or a fracture to recognize one helps X-ray. This enables a relatively good assessment of the bony spine and can be carried out quickly.

For an exact investigation and finding the cause, however, the Magnetic resonance imaging of the lumbar spine (MRI) the best method of investigation. This allows both the Soft tissuesas well as the bones and the spinal canal of the lumbar spine.
In addition, the Spinal canal the lumbar spine. This also makes the smallest constrictions of the spinal canal visible. (Spinal stenosis of the lumbar spine)

Since the investigation, however relatively long lasts (approx. 30 min) and the patient during this time completely calm and flat must be, in acute cases a Computed tomogram (CT) performed. While this means a relative high radiation exposure for the patient, but enables a good representation of the vertebral bodies and the intervertebral discs. For this reason, it is used in an emergency and for quick diagnosis always a CT first performed the lumbar spine.