Sciatiques et autres lomboradiculalgies discales

Abstract

Sciatica induced by a disc herniation is the result of both mechanical and chemical actions on nerve roots inside the lumbar canal. The main factors of inflammation seem to be interleukin 1 and tumor necrosis factor α. To be compressive, the herniation should be large. The diagnosis of sciatica by disc herniation is at first clinical. The association of a crossed Lasègue's sign and the increase of the leg pain during lumbar extension could have a good predictive value of disc herniation. The natural course of sciatica by disc herniation is not only good concerning the symptom but also concerning the herniation which decreases or disappears in more than 50 % of the cases. Except in cauda equina syndrom and in worsening paresis, the surgery can be delayed without endangering the prognosis.