Wednesday, July 28, 2010

Sciatic Nerve--what the heck is it?

I'm going to spare much of the scientific jargon here and make this one simple. The sciatic nerve (hence sciatica-associated pain) is formed from smaller nerves running from the lumbar to the sacral nerves, and is composed in the leg and then further branches off into smaller sections. It is responsible for a lot of the pain in those with bad disks, spondy, or other similar conditions. Irritation is typically pain, sometimes numbness/pins needles, however if major or in cases of sudden onset sensory deprivation or extremity paralysis it indicates acute damage and should be treated emergently.

Different location of pain differentiates spinal level
However the nerve itself does not just jump out of the spine. It is actually several nerves emerging from the lumbar vertebrae and sacral openings that merge into a big bundle that becomes the sciatic nerve. What is important here is that the location of the pain is critical to determining the level that is injured in the spine. Here is one diagram to the right that shows an approximation of which nerve is responsible for which pain. The one on the right is very broad, whereas the one below is much more specific.

This diagram demonstrates a "map" of the nerve origination vs the location of pain felt.

Why am I spending so much time on this? Because the pattern of pain I have been experiencing is the s2/s3 variety. That means it is just inflammatory pain from the surgery, perhaps the radical reduction, or just too much walking. The MD's office agrees, slow it the heck down. 4 miles is too long to walk less than a week post-op (ok ok I was excited to be able to walk again...)

So today it has been better. Today is also my first full day off all narcs--and that will get its own post, but let me tell you it is not pleasant. However I've seen far too many patients go down the path of not stopping soon enough, and I'd rather stop a little too soon and play it safe. So what, what's a little pain now compared to the last year. Actually with the fixation there is very little back pain, and I forget I even had abdominal surgery unless I sneeze or cough. Not bad for less than two weeks out. Now the legs--that will remain for the next post.

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