Abstract

A CLINICAL STUDY ON THE AETIOPATHOGENESIS OF VATAJA AND VATAKAPHAJA TYPE OF GRIDHRASI W.S.R TO SCIATICA

Rohitas Paswan* and Sunil Kumar Gupta

ABSTRACT

Radicular pain in the distribution of the sciatic nerve, resulting from herniation of one or more lumbar intervertebral discs, is a frequent and often debilitating event. The lifetime incidence of this condition is estimated to be between 13% and 40%. Fortunately, the majority of cases resolve spontaneously with simple analgesia and physiotherapy. However, the condition has the potential to become chronic and intractable, with major socio-economic implications. The sciatic nerve is the longest nerve in your body. It runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet. The pain of sciatica is usually felt in the buttocks and legs. Most people find it goes away naturally within a few weeks, although some cases can last for a year or more. Epidemiological factors found to influence incidence of sciatica included increasing height, age, genetic predisposition, walking, jogging (if a previous history of sciatica), and particular physical occupations, including driving. The influence of herniated nucleus pulpous and the probable cytokine-mediated inflammatory response in lumbar and sacral nerve roots is discussed. An abnormal immune response and possible mechanical factors are also proposed as factors that may mediate pain. The ongoing issue of the role of epidural steroid injection in the treatment of this condition is also discussed, as well as potential hazards of this procedure and the direction that future research should take. Sciatica is a debilitating condition in which the patient experiences pain and/or paresthesias in the distribution of the sciatic nerve or an associated lumbosacral nerve root. Often, a common mistake is referring to any low back pain or radicular leg pain as sciatica. Sciatica is specific to the pain that is a direct result of sciatic nerve or sciatic nerve root pathology. The sciatic nerve is made up of the L4 through S2 nerve roots which coalesce at the pelvis to form the sciatic nerve. At up to 2 cm in diameter, the sciatic nerve is easily the largest nerve in the body. Sciatica pain often is worsened with flexion of the lumbar spine, twisting, bending, or coughing. The sciatic nerve provides direct motor function to the hamstrings, lower extremity adductors, and indirect motor function to the calf muscles, anterior lower leg muscles, and some intrinsic foot muscles. Also, indirectly through its terminal branches, the sciatic nerve provides sensation to the posterior and lateral lower leg as well as the plantar foot. It is an important distinction to know that most cases of sciatica result from an inflammatory condition leading to an irritation of the sciatic nerve. Conversely, direct compression of the nerve leads to more severe motor dysfunction which is often not seen, and if present, would warrant a more meticulous and expeditious workup.

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