- \n
- Stadiul I \u2013 Faza acut\u0103<\/li>\n
- Stadiul II \u2013 Irita\u021bia nervoas\u0103 progresiv\u0103 a nervului sciatic<\/li>\n
- Stadiul III \u2013 Compresia cronic\u0103 a nervului sciatic<\/li>\n
- Stadiul IV \u2013 Faza avansat\u0103<\/li>\n<\/ul>\n
![\"\"](\"https:\/\/roneuro.ro\/blog\/wp-content\/uploads\/2019\/01\/stadiile-lombosciaticii.jpg\" "\\"\\"")
<\/p>\nFiecare stadiu al lombosciaticii are caracteristici distincte, precum stres muscular, irita\u021bia nervului sciatic, contracturi musculare, durere radiant\u0103, deficien\u021be neurologice \u0219i altele [3], care pot fi\u00a0 categorisite astfel:<\/p>\n
Stadiul I – Faza acut\u0103<\/h3>\n
Unul dintre simptomele primului stadiu este reprezentat de durere lombar\u0103 u\u0219oar\u0103 p\u00e2n\u0103 la moderat\u0103, adesea intermitent\u0103 \u0219i pozi\u021bional\u0103 [4], de asemenea, apar semne precoce de irita\u021bie a nervilor precum \u00een\u021bep\u0103turi sau furnic\u0103turi de-a lungul distribu\u021biei nervului sciatic \u00een fese, coapse, picioare sau laba piciorului [5].\u00a0 Pot ap\u0103rea contrac\u021bii musculare \u00een partea inferioar\u0103 a spatelui sau a mu\u0219chilor care se \u00eentind de la baza pelvisului p\u00e2n\u0103 la partea superioar\u0103 a genunchiului [6]), dar reflexele, for\u021ba \u0219i senza\u021bia sunt de obicei normale.<\/p>\n
Stadiul II – Irita\u021bia nervoas\u0103 progresiv\u0103 a nervului sciatic<\/h3>\n
Simptomele cele mai frecvente din stadiul II sunt durerile lombare, frecvente \u0219i severe [7], dureri radiale, care se propag\u0103 de-a lungul c\u0103ii nervului sciatic \u00een piciorul st\u00e2ng sau drept [8]), amor\u021beli sau senza\u021bie de furnic\u0103turi la nivelul piciorului afectat [9]. Pe l\u00e2ng\u0103 acestea mai poate ap\u0103rea sl\u0103biciune muscular\u0103 la nivelul piciorului sau labei afectate [10], \u0219i dificult\u0103\u021bi \u00een men\u021binerea posturii din cauza durerii [11].<\/p>\n
Stadiul III – Compresia cronic\u0103 a nervului sciatic<\/h3>\n
Stadiul III al lombosciaticii este caracterizat prin durere radial\u0103, persistent\u0103 \u0219i sever\u0103, adesea insensibil\u0103 la analgezicele tipice [12], sl\u0103biciune muscular\u0103 pronun\u021bat\u0103 (de exemplu, dificultate \u00een a sta pe degetele de la picioare sau pe c\u0103lc\u00e2ie [13]), precum \u0219i amor\u021beal\u0103 semnificativ\u0103 \u00een anumite zone ale piciorului [14]. Deasemenea, \u00een acest stadiu se observ\u0103 reflexe diminuate la nivelul genunchiului sau gleznei [15] \u0219i dificult\u0103\u021bi crescute la mers, stat \u00een picioare sau desf\u0103\u0219urarea activit\u0103\u021bilor zilnice [16].<\/p>\n
Stadiul IV – Faza avansat\u0103<\/h3>\n
\u00cen acest stadiu, durerea este persistent\u0103 \u0219i debilitant\u0103, interfer\u00e2nd cu somnul \u0219i calitatea vie\u021bii [17]. Apare atrofie muscular\u0103 semnificativ\u0103 care poate conduce la paralizie \u00een zonele afectate, pierderea senzorial\u0103 este complet\u0103, gener\u00e2nd instabilitate postural\u0103 sever\u0103 (de exemplu, dificult\u0103\u021bi majore \u00een men\u021binerea echilibrului sau a posturii [18]. \u00cen unele cazuri, a fost observat\u0103 \u0219i disfunc\u021bie intenstinal\u0103\/vezic\u0103 urinar\u0103, put\u00e2nd favoriza apari\u021bia sindromului cauda equina<\/em> dac\u0103 compresia este sever\u0103, rezult\u00e2nd incontinen\u021b\u0103 sau reten\u021bie urinar\u0103 [19]).<\/p>\n
Lombosciatica nu ajunge neap\u0103rat p\u00e2n\u0103 \u00een faza final\u0103, deoarece interven\u021bia timpurie poate opri evolu\u021bia atenu\u00e2nd semnificativ simptomele. Sindromul cauda equina<\/em> este o urgen\u021b\u0103 medical\u0103 \u0219i necesit\u0103 aten\u021bie imediat\u0103, pentru a preveni daunele permanente ale nervilor, care pot genera paralizie, incontinen\u021b\u0103 sau alte afec\u021biuni cronice. Tratamentul variaz\u0103 \u00een func\u021bie de etap\u0103, incluz\u00e2nd fizioterapie, gestionarea durerii \u0219i uneori interven\u021bie chirurgical\u0103 pentru cazurile grave.<\/p><\/blockquote>\n
Resurse \u0219i suport pentru pacien\u021bi<\/h2>\n
Dac\u0103 ave\u021bi oricare din simptomele descrise anterior \u0219i crede\u021bi c\u0103 este vorba de lombosciatic\u0103, programa\u021bi-v\u0103 acum la un consult <\/span>contact\u00e2nd recep\u021bia Institutului RoNeuro<\/strong> la num\u0103rul de telefon<\/span> 0374 46 2222<\/a><\/b>, luni \u0219i mar\u021bi \u00eentre orele 08:00 – 19:00<\/strong>, iar de miercuri p\u00e2n\u0103 vineri \u00eentre orele 08:00 – 18:00<\/strong>.\u00a0<\/span><\/p>\n
La momentul program\u0103rii, pute\u021bi opta \u0219i pentru consulta\u021bie neurologic\u0103 gratuit\u0103, decontat\u0103 prin Casa Na\u021bional\u0103 de Asigur\u0103ri de S\u0103n\u0103tate.\u00a0<\/span><\/p>\n
Program\u0103ri online neurologie<\/a><\/p>\n
Locui\u021bi \u00eentr-o zon\u0103 izolat\u0103 sau nu v\u0103 pute\u021bi deplasa la clinic\u0103? Institutul RoNeuro ofer\u0103 \u0219i op\u021biunea de <\/span>telemedicin\u0103<\/a>.<\/b><\/p>\n
Care sunt cauzele lombosciaticii?<\/h2>\n
Lombosciatica este cel mai des \u00eent\u00e2lnit\u0103 \u00een intervalul de v\u00e2rste cuprins \u00eentre 20 \u0219i 50 ani [20]. Prin urmare, cauzele acesteia pot fi delimitate pe mai multe grupe:<\/p>\n
- \n
- Cauze structurale, mecanice;<\/li>\n
- Cauze metabolice;<\/li>\n
- Cauze inflamatorii \u0219i autoimune;<\/li>\n
- Cauze tumorale;<\/li>\n
- Cauze vasculare \u0219i neurologice;<\/li>\n
- Alte cauze.<\/li>\n<\/ul>\n
![\"\"](\"https:\/\/roneuro.ro\/blog\/wp-content\/uploads\/2019\/01\/cauzele-lombosciaticii.jpg\" "\\"\\"")
<\/p>\nCauze structurale\/mecanice<\/h3>\n
Cele mai des \u00eent\u00e2lnite cauze structurale\/mecanice sunt herniile \u0219i bolile degenerative discale, stenoza spinal\u0103, traumatismele \u0219i complica\u021biile postchirurgicale:<\/p>\n
- \n
- Hernie de disc<\/strong> (materialul discului apas\u0103 pe r\u0103d\u0103cinile nervoase [21]);<\/li>\n
- Boala degenerativ\u0103 a discului intervertebral<\/strong><\/a> (uzura mecanic\u0103 a discului comprim\u0103 nervul sciatic [22]);<\/li>\n
- Stenoz\u0103 spinal\u0103<\/strong> (\u00eengustarea canalului spinal comprim\u0103 nervul sciatic [23]);<\/li>\n
- Spondilolistez\u0103<\/strong> (vertebra alunec\u0103 din loc ap\u0103s\u00e2nd nervul sciatic [24]);<\/li>\n
- Sindromul piriformis<\/strong> (spasmul mu\u0219chiului piriformis care comprim\u0103 nervul sciatic [25]);<\/li>\n
- Traumatisme\/leziuni<\/strong> (fracturi ale coloanei vertebrale sau pelvisului care ating nervul sciatic [26]);<\/li>\n
- Complica\u021bii postchirurgicale<\/strong> (cicatrici sau leziuni ale nervilor \u00een urma opera\u021biilor la coloana vertebral\u0103 [27]).<\/li>\n<\/ul>\n
Cauze metabolice<\/h3>\n
Trebuie avut \u00een vedere faptul c\u0103 orice afec\u021biune care afecteaz\u0103 structural sau comprim\u0103 nervul sciatic poate provoca simptome de sciatic\u0103. Cauzele metabolice ale lombosciaticii sunt diabetul, obezitatea \u0219i guta tofacee spinal\u0103:<\/p>\n
- \n
- Diabetul zaharat<\/strong> (poate favoriza neuropatia diabetic\u0103, inclusiv cea sciatic\u0103 [28]);<\/li>\n
- Obezitate<\/strong> (excesul de greutate adaug\u0103 presiune asupra coloanei vertebrale \u0219i a nervului sciatic [29]);<\/li>\n
- Gut\u0103 cronic\u0103 tofacee spinal\u0103<\/strong> (guta poate provoca un r\u0103spuns inflamator \u00een coloana vertebral\u0103, favoriz\u00e2nd durerea sciatic\u0103 [30]).<\/li>\n<\/ul>\n
Cauze inflamatorii \u0219i autoimune<\/h3>\n
Lombosciatica nu este cauzat\u0103 doar de compresie sau \u00eentindere mecanic\u0103, ci \u0219i de stimulare chimic\u0103 \u0219i r\u0103spuns imun [31]. Persoanele cu sciatic\u0103 prezint\u0103 caracteristici inflamatorii \u0219i imune care pot fi detectate \u00een s\u00e2ngele periferic [32].<\/p>\n
- \n
- Artrit\u0103<\/strong> (inclusiv osteoartrit\u0103, artrit\u0103 reumatoid\u0103, boli care afecteaz\u0103 coloana vertebral\u0103 datorit\u0103 inflama\u021biei cronice);<\/li>\n
- Spondilita anchilozant\u0103<\/strong> (inflama\u021bie cronic\u0103 a coloanei vertebrale \u0219i a articula\u021biilor sacroiliace);<\/li>\n
- Infec\u021bii <\/strong>(la nivelul coloanei vertebrale precum abces spinal, tuberculoz\u0103, etc);<\/li>\n
- Vasculit\u0103<\/strong> (inflama\u021bia vaselor de s\u00e2nge poate afecta alimentarea cu s\u00e2nge a nervului).<\/li>\n<\/ul>\n
Cauze tumorale<\/h3>\n
Tumorile care cresc \u00een apropierea nervului sciatic pot s\u0103 favorizeze dureri [33]. De exemplu o tumor\u0103 malign\u0103 sciatic\u0103 reprezint\u0103 o cre\u0219tere anormal\u0103 a \u021besutului din regiunea coloanei vertebrale \u0219i\u00a0 poate ap\u0103rea \u00een m\u0103duva spin\u0103rii [34].<\/p>\n
- \n
- Tumori spinale<\/strong> (care comprim\u0103 nervul sciatic);<\/li>\n
- Chisturi pelvine sau abdominale<\/strong> (care exercit\u0103 presiune asupra nervului sciatic);<\/li>\n
- Cancer metastatic<\/strong> (care ajunge p\u00e2n\u0103 la nivelul coloanei vertebrale sau pelvisului).<\/li>\n<\/ul>\n
Cauze vasculare \u0219i neurologice<\/h3>\n
\u00cen cazuri mai rare, unele patologii pot s\u0103 produc\u0103 dureri sciatice nondiscogene [35], precum dilatarea anormal\u0103 a vaselor de s\u00e2nge (anevrism) din apropierea nervului sciatic [36], sc\u0103derea sau blocarea fluxului sanguin (ischemie) c\u0103tre nervul sciatic sau leziuni ale nervilor, \u0219i leziuni ale termina\u021biilor nervoase precum neuropatia periferic\u0103 sau sciatic\u0103 [37].<\/p>\n
- \n
- Anevrisme;<\/li>\n
- Ischemie;<\/li>\n
- Neuropatie periferic\u0103.<\/li>\n<\/ul>\n
Alte cauze ale lombosciaticii<\/h3>\n
\u00cen anumite situa\u021bii, durerile specifice de lombosciatic\u0103 pot s\u0103 apar\u0103 de la: postura incorect\u0103 \u0219i prelungit\u0103 la birou, \u00eembr\u0103c\u0103mintea prea str\u00e2mt\u0103, ergonomie deficitar\u0103, modific\u0103ri hormonale (\u00een special la femeile gravide). \u00cen alte cazuri, deplas\u0103rile posturale pot irita nervul sciatic. Pozi\u021bia membrelor \u0219i a coloanei vertebrale poate influen\u021ba tensiunea inerent\u0103 a unui tract nervos periferic \u0219i, prin urmare, poate influen\u021ba excursia nervilor \u0219i amplitudinea mi\u0219c\u0103rii articulare pe m\u0103sur\u0103 ce corpul se mi\u0219c\u0103 [38].<\/p>\n
Concluzii<\/h2>\n
Lombosciatica este o durere cauzat\u0103 de o leziune sau irita\u021bie a nervului sciatic. Pe l\u00e2ng\u0103 durere, pot ap\u0103rea senza\u021bii de furnic\u0103turi sau amor\u021beal\u0103 la nivelul spatelui sau feselor.<\/p>\n
Cazurile u\u0219oare de durere sciatic\u0103 se amelioreaz\u0103 \u00een timp. Cu toate acestea, dac\u0103 nu este tratat\u0103, lombosciatica poate provoca leziuni permanente ale nervilor agrav\u00e2nd durerile de spate \u0219i de picioare. \u00cen timp, durerea se poate extinde la alte p\u0103r\u021bi ale corpului.<\/p>\n
Este important ca planul de tratament s\u0103 \u00eenceap\u0103 c\u00e2t mai cur\u00e2nd posibil, deoarece promptitudinea interven\u021biei medicale poate avea un impact semnificativ asupra rezultatelor pe termen lung, evit\u00e2ndu-se apari\u021bia complica\u021biilor.<\/p>\n
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- Bickels J, Kahanovitz N, Rubert CK, Henshaw RM, Moss DP, Meller I, Malawer MM. Extraspinal bone and soft-tissue tumors as a cause of sciatica. Clinical diagnosis and recommendations: analysis of 32 cases. Spine (Phila Pa 1976). 1999 Aug 1;24(15):1611-6. doi: 10.1097\/00007632-199908010-00017. Available at: https:\/\/pubmed.ncbi.nlm.nih.gov\/10457583\/<\/a><\/li>\n
- Rodero L, Canga A, Figols J, Berciano J, Combarros O. Masa gl\u00fatea y tumor maligno del nervio ci\u00e1tico [Buttock mass and malignant sciatic nerve tumor]. Neurologia. 2004 Jan-Feb;19(1):27-31. Spanish. Available at: https:\/\/pubmed.ncbi.nlm.nih.gov\/14762732\/<\/a><\/li>\n
- Hu MH, Wu KW, Jian YM, Wang CT, Wu IH, Yang SH. Vascular compression syndrome of sciatic nerve caused by gluteal varicosities. Ann Vasc Surg. 2010 Nov;24(8):1134.e1-4. doi: 10.1016\/j.avsg.2010.02.043. Epub 2010 May 15. Available at: https:\/\/pubmed.ncbi.nlm.nih.gov\/20472387\/<\/a><\/li>\n
- Geelen JA, de Graaff R, Biemans RG, Prevo RL, Koch PW. Sciatic nerve compression by an aneurysm of the internal iliac artery. Clin Neurol Neurosurg. 1985;87(3):219-22. doi: 10.1016\/0303-8467(85)90011-3. Available at: https:\/\/pubmed.ncbi.nlm.nih.gov\/4053476\/<\/a><\/li>\n
- Yuen EC, So YT. Sciatic neuropathy. Neurol Clin. 1999 Aug;17(3):617-31, viii. doi: 10.1016\/s0733-8619(05)70155-9. Available at: https:\/\/pubmed.ncbi.nlm.nih.gov\/10393756\/<\/a><\/li>\n
- Ellis R, Osborne S, Whitfield J, Parmar P, Hing W. The effect of spinal position on sciatic nerve excursion during seated neural mobilisation exercises: an in vivo study using ultrasound imaging. J Man Manip Ther. 2017 May;25(2):98-105. doi: 10.1179\/2042618615Y.0000000020. Available at: https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC5430455\/<\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
Ce este lombosciatica? Lombosciatica este o afec\u021biune debilitant\u0103 \u00a0care afecteaz\u0103 nervul sciatic sau r\u0103d\u0103cinile nervoase din zona lombar\u0103 \u0219i sacral\u0103. Aceasta se manifest\u0103 prin dureri care pot iradia de la zona lombar\u0103 \u00een jos, pe partea posterior\u0103 a coapsei, p\u00e2n\u0103 \u00een gamb\u0103 sau picior, \u0219i este adesea \u00eenso\u021bit\u0103 de senza\u021bii de amor\u021beal\u0103, furnic\u0103turi sau sl\u0103biciune […]<\/p>\n","protected":false},"author":1,"featured_media":700,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"jnews-multi-image_gallery":[],"jnews_single_post":{"source_name":"","source_url":"","via_name":"","via_url":"","override_template":"0","override":[{"template":"1","single_blog_custom":"","parallax":"1","fullscreen":"1","layout":"right-sidebar","sidebar":"default-sidebar","second_sidebar":"default-sidebar","sticky_sidebar":"1","share_position":"top","share_float_style":"share-monocrhome","show_share_counter":"1","show_view_counter":"1","show_featured":"1","show_post_meta":"1","show_post_author":"1","show_post_author_image":"1","show_post_date":"1","post_date_format":"default","post_date_format_custom":"Y\/m\/d","show_post_category":"1","show_post_reading_time":"0","post_reading_time_wpm":"300","show_zoom_button":"0","zoom_button_out_step":"2","zoom_button_in_step":"3","show_post_tag":"1","show_prev_next_post":"1","show_popup_post":"1","number_popup_post":"1","show_author_box":"0","show_post_related":"0","show_inline_post_related":"0","post_calculate_word_method":"str_word_count"}],"override_image_size":"0","image_override":[{"single_post_thumbnail_size":"crop-500","single_post_gallery_size":"crop-500"}],"trending_post":"0","trending_post_position":"meta","trending_post_label":"Trending","sponsored_post":"0","sponsored_post_label":"Sponsored by","sponsored_post_name":"","sponsored_post_url":"","sponsored_post_logo_enable":"0","sponsored_post_logo":"","sponsored_post_desc":"","disable_ad":"0","format":"standard","subtitle":""},"jnews_primary_category":{"id":"","hide":""},"jnews_override_counter":{"override_view_counter":"0","view_counter_number":"0","override_share_counter":"0","share_counter_number":"0","override_like_counter":"0","like_counter_number":"0","override_dislike_counter":"0","dislike_counter_number":"0"},"footnotes":""},"categories":[6],"tags":[],"class_list":["post-118","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-neurologie"],"_links":{"self":[{"href":"https:\/\/roneuro.ro\/blog\/wp-json\/wp\/v2\/posts\/118","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/roneuro.ro\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/roneuro.ro\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/roneuro.ro\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/roneuro.ro\/blog\/wp-json\/wp\/v2\/comments?post=118"}],"version-history":[{"count":3,"href":"https:\/\/roneuro.ro\/blog\/wp-json\/wp\/v2\/posts\/118\/revisions"}],"predecessor-version":[{"id":1813,"href":"https:\/\/roneuro.ro\/blog\/wp-json\/wp\/v2\/posts\/118\/revisions\/1813"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/roneuro.ro\/blog\/wp-json\/wp\/v2\/media\/700"}],"wp:attachment":[{"href":"https:\/\/roneuro.ro\/blog\/wp-json\/wp\/v2\/media?parent=118"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/roneuro.ro\/blog\/wp-json\/wp\/v2\/categories?post=118"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/roneuro.ro\/blog\/wp-json\/wp\/v2\/tags?post=118"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
- Mostofi K, Peyravi M, Moghaddam BG. A comparison of sciatica in young subjects and elderly person. J Clin Orthop Trauma. 2020 Sep-Oct;11(5):889-890. doi: 10.1016\/j.jcot.2019.07.011. Epub 2019 Jul 24. Available at: https:\/\/pubmed.ncbi.nlm.nih.gov\/32879576\/<\/a><\/li>\n
- Zitouna K, Selmene MA, Derbel B, Rekik S, Drissi G, Barsaoui M. An unexpected etiology of lumbosciatica. Tunis Med. 2019 Dec;97(12):1415-1418. Available at: https:\/\/pubmed.ncbi.nlm.nih.gov\/32173813\/<\/a><\/li>\n
- Chisturi pelvine sau abdominale<\/strong> (care exercit\u0103 presiune asupra nervului sciatic);<\/li>\n
- Spondilita anchilozant\u0103<\/strong> (inflama\u021bie cronic\u0103 a coloanei vertebrale \u0219i a articula\u021biilor sacroiliace);<\/li>\n
- Obezitate<\/strong> (excesul de greutate adaug\u0103 presiune asupra coloanei vertebrale \u0219i a nervului sciatic [29]);<\/li>\n
- Boala degenerativ\u0103 a discului intervertebral<\/strong><\/a> (uzura mecanic\u0103 a discului comprim\u0103 nervul sciatic [22]);<\/li>\n
- Hernie de disc<\/strong> (materialul discului apas\u0103 pe r\u0103d\u0103cinile nervoase [21]);<\/li>\n