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PubMed2001

Eight year outcome after surgery for lumbar disc herniation: a comparison of reoperated and not reoperated patients.

A retrospective study of 211 patients with unilateral sciatica operated on for lumbar disc herniation during 1988 and 1989 was performed in order to compare the results of reoperated patients with the results of patients operated on only once. The patients completed a standardized questionnaire in 1997 which included questions about reoperations, back and leg pain, functional status and disability pension. Outcome scores were calculated, giving values from 0 (no pain/normal function) to 100 (totally disabled). A follow-up status of 80.1% was obtained; 163 patients answered the questionnaire while six patients had died. 23.9% of the patients (n = 39) had been reoperated on. A recurrent disc herniation at the same level was suspected before the reoperation in 18.4%, but a recurrence was found in only 8.6%. 3.7% were reoperated on more than once. Outcome score was worse among "reoperated" patients (median 45.0, range 0-94) than among patients who only had the primary operation (median 10.5, range 0-81) (P < 0.001). In addition, 34.3% of the "reoperated" patients received a disability pension compared to 9.9% of the patients not reoperated on (P < 0.01). Patients reoperated upon at the same level without peroperative signs of recurrent disc herniation, had an outcome score of 53.0 (range 0-82) compared to a score of 30.0 (range 0-66) in patients with a confirmed recurrence (P < 0.05). The percentage of disability pension was 53.8% versus 9.1%, respectively, for those two groups (P < 0.05). Eight years after operation for lumbar disc herniation, the outcome was significantly worse in "reoperated" patients than in patients operated on once. In addition, reoperated patients with peroperatively confirmed recurrence of the same disc, seemed to have a better outcome than patients without peroperative signs of a recurrence.

Adult↗

PubMed2003

Osteochondroma in the lumbar spinal canal causing sciatic pain: report of two cases.

A search of the English-language medical literature found only two cases in which expansion of an osteochondroma into the lumbar spinal canal caused sciatica. We report another two cases of spinal nerve root compression by solitary lumbar spinal canal osteochondromas: in a 56-year-old man and a 55-year-old woman with no history of hereditary multiple exostoses. Osteochondromas compressing the spinal nerve root were seen at the inferior articular processes of the lumbar vertebrae by computed tomography (CT), three-dimensional reconstruction of CT scans, myelography, and magnetic resonance imaging. The symptoms disappeared after surgical removal of the lesions. Histopathologic examination confirmed the diagnosis of benign osteochondroma.

Female↗

PubMed2005

Coronal oblique turbo STIR imaging of the sacrum and sacroiliac joints at routine MR imaging of the lumbar spine.

The objective of the study was to evaluate the clinical impact of coronal oblique imaging of the lumbrosacral junction and the sacrum at initial presentation for MR imaging of the lumbar spine in patients presenting with low back pain or sciatic pain. Two hundred and sixty consecutive patients attending for MRI of the lumbar spine underwent simultaneous coronal oblique turbo short tau inversion recovery (STIR; TR 2500, TE 40, TI 150, echo train length 7, number of scan acquisitions 2) imaging of the sacrum and the sacroiliac joints with a field of view of 30-cm and 3-mm slices (acquisition time 3 min and 20 s). Images were reviewed by two experienced radiologists to determine the cause of back pain, with and without images of the sacrum and sacroiliac joints. The added value of the additional sequence was assessed. Correlation was made with surgery, response to nerve root injection or clinical follow-up at 3 months. Subgroup analysis was performed to determine if patient stratification according to sex or symptoms would be useful. In total, in 19 of 260 patients (7.3%), abnormalities were identified at coronal STIR imaging. In 7 of 260 patients (2.7%), pathology was identified in the sacrum thought to account for back pain, altering the diagnosis made on the standard sequences. These diagnoses were sacroiliitis (n=2), sacral stress fracture (n=1), degenerative sacroiliac joints (n=1), degenerative accessory articulation between the lumbar spine and the sacrum (n=1), Tarlov cyst of nerve root (n=1) and retroverted uterus causing sciatic pain (n=1). Patient stratification according to sex or the presence or absence of sciatic symptoms was not useful in predicting the added benefit of the additional sequence. Routine coronal STIR imaging of the sacrum as part of lumbar spine MRI improves assessment of patients presenting with low back pain or sciatica in only a small number of patients.

Acute Disease↗

PubMed2002

Microscopically assisted percutaneous nucleotomy, an alternative minimally invasive procedure for the operative treatment of lumbar disc herniation: preliminary results.

Lumbar discectomy is one of the most frequent neurosurgical and orthopaedic procedures. In this study, a series of 43 consecutive patients operated with a minimally invasive technique referred to as "microscopically assisted percutaneous nucleotomy" (MAPN) is presented. After a follow-up period of 3 months, every patient was seen clinically, and after 12 months, telephone enquiries were performed by the first author. There were two recurrences. The results in improvement of sciatica and neurologic deficit corresponded to common microdiscectomy series with 80% excellent and good results. The MAPN method is compared with common microdiscectomy with regard to operating time, technical procedure, and especially in surgical indications. It proved to have the same effectivity in the treatment of lumbar disc herniations, however, with less approach damage.

Adult↗

PubMed1995

Endometriosis of the sciatic nerve: case report demonstrating the value of MR imaging.

Among the many causes of sciatica, endometriosis, a rare aetiology, should be considered in menstruating women in view of the diagnostic strategy and ensuing therapeutic implications. We report a case of sciatic nerve involvement with endometriosis in contact with the nerve in the left sciatic notch. Exploration by MRI was invaluable for the diagnosis, revealing a signal on the stem of the nerve suggestive of a lesion with haemorrhagic content.

Adult↗

PubMed1984

Computed tomography in pelvic liposarcoma: a case report.

A case of well-differentiated pelvic liposarcoma with unusual presentation of low-back pain and sciatica, due to the herniation through the greater sciatic notch, is described. Computed tomography is invaluable, not only in predicting the histologic diagnosis, but also in outlining the location, extent, and size of the tumor. This allows accurate planning of the surgical approach.

Back Pain↗

PubMed1984

IgE in the cerebrospinal fluid.

The level of IgE in the cerebrospinal fluid (CSF) was determined by particle counting immunoassay. With a limit of sensitivity of 0.2 IU/ml, this immunoglobulin was detected neither in CSF of non-neurological patients (n = 27) nor of patients with sciatica (n = 13). IgE was present in samples from some patients with either multiple sclerosis (MS) or various infections of the central nervous system. In these cases, an IgE index [CSF IgE/serum IgE: CSF albumin/serum albumin] was calculated as 0.29 (SD 0.12). This value is not abnormal as the mean IgG and monomeric IgA indices are 0.45 and 0.34, respectively. Therefore, the IgE detected in most of the CSF samples was not locally produced. However, most patients with tuberculous meningitis had clearly an increased IgE index suggesting a local biosynthesis, but we failed to detect any IgE antibody activity against purified protein derivatives.

Antibody Specificity↗

PubMed1995

Subject-based P1 latency inter-root comparison, a method to evaluate P1 latency in scalp recorded somatosensory evoked potentials obtained with sensory nerve stimulation in the lower extremities.

The purpose of the present study was to establish a method that allows the general use of subject-based criteria to evaluate P1 latency in scalp recorded somatosensory evoked potentials obtained with stimulation of the sural (S1), superficial peroneal (L5) and saphenous (L4) nerves bilaterally. The nerves were stimulated at the same distance from the registration electrode. Two groups of normal nerve roots were studied: (1) nerve roots on both sides in 20 asymptomatic volunteers, and (2) neuroradiologically normal nerve roots on the asymptomatic side in 22 patients with unilateral sciatica. The results presented show that the P1 latencies after stimulation of the 6 different nerves in the same person can be regarded as equal. On this basis 2 criteria to evaluate P1 latency by within-subject P1 latency inter-root comparison were defined. They were the difference between P1 latency of 1 registration and (1) that of any one of the other 5 registrations and (2) the mean P1 latency of the other registrations. The variability of these subject-based criteria and the width of their reference limits were compared to those of the population-based criteria of height- and height-age-corrected P1 latency. This comparison showed that the use of within-subject P1 latency inter-root comparison should enhance the ability to demonstrate small bilateral P1 latency prolongations at the same segmental level.

Adult↗

PubMed1994

Microdiscectomy for lumbar disc herniation.

Microscopical lumbar discectomy is nowadays a very common neurosurgical procedure. The technique has been introduced more than 15 years ago. For the present study a series of 100 consecutive patients, operated upon by one surgeon and with a follow-up period of at least 1 year, was reviewed. The importance of a clean surgical indication is stressed. At the latest follow-up examination 3 patients still complained of moderately intense sciatica and 1 of backache of an invalidating degree. Four patients needed a second operation for a recurrent herniation at the same or another level. Eventually, 96 patients were able to resume their previous, if available, professional activities.

Adult↗

PubMed1983

Relief from chronic pain by low power laser irradiation.

In a double blind study, repeated irradiation with a low-power (1 mW) helium-neon laser produced relief in subjects with chronic pain. Analgesia was observed after exposure of the skin overlying the radial, medial and saphenous nerves and in some cases, irradiation of the appropriate painful nerve. Exposure of areas of skin not innervated by these nerves did not result in pain relief. Of the patients with trigeminal neuralgia, post-herpetic neuralgia, sciatica and ostearthritis, 19 of 26 experienced pain relief without the use of drugs. Patients who received sham stimulation reported no analgesia. Subjects who were exposed to laser irradiation had a large increase in the urinary excretion of 5-hydroxyindoleacetic acid, the degradation product of serotonin.

Chronic Disease↗

PubMed1977

Facet "denervation" in the treatment of low back syndrome.

Long-term pain relief occurred in 21% of patients with low back and leg pain who underwent injection or radiofrequency rhizotomy. When pain was accompanied by unequivocal limitation of straight leg raising, neither injection nor rhizotomy produced long-term relief. Leg pain improved more than low back pain. Improvement was limited to pain relief as reported to the physician and reduction of medication. There was no improvement in work or activity status. Despite the low success rate, facet "denervation" is uncommonly safe and seems to be of some usefulness in the treatment of patients with low back pain and sciatica.

Anesthesia, Local↗

PubMed1977

Mechanosensitivity of dorsal root ganglia and chronically injured axons: a physiological basis for the radicular pain of nerve root compression.

The radicular pain of sciatica was ascribed by Mixter and Barr to compression of the spinal root by a herniated intervertebral disc. It was assumed that root compression produced prolonged firing in the injured sensory fibers and led to pain perceived in the peripheral distribution of those fibers. This concept has been challenged on the basis that acute peripheral nerve compression neuropathies are usually painless. Furthermore, animal experiments have rarely shown more than several seconds of repetitive firing in acutely compressed nerves or nerve roots. It has been suggested that "radicular pain" is actually pain referred to the extremity through activation of deep spinal and paraspinal nociceptors. Our experiments on cat lumbar dorsal roots and rabbit sural nerves have confirmed that acute compression of the root or nerve does not produce more than several seconds of repetitive firing. However, long periods of repetitive firing (5-25 min) follow minimal acute compression of the normal dorsal root ganglion. Chronic injury of dorsal roots or sural nerve produces a marked increase in mechanical sensitivity; several minutes of repetitive firing may follow acute compression of such chronically injured sites. Such prolonged responses could be evoked repeatedly in a population of both rapidly and slowly conducting fibers. Since mechanical compression of either the dorsal root ganglion or of chronically injured roots can induce prolonged repetitive firing in sensory axons, we conclude that radicular pain is due to activity in the fibers appropriate to the area of perceived pain.

Action Potentials↗

PubMed1987

Brain evoked potentials to noxious sural nerve stimulation in sciatalgic patients.

In sciatalgic patients and before any treatment, the goal of this work was to compare the amplitude of the late component (N150-P220) of the brain evoked potential (BEP) between resting pain-free conditions and a neurological induced pain produced by the Lasègue manoeuvre. The study was carried out with 8 inpatients affected with a unilateral sciatica resulting from an X-ray identified dorsal root compression from discal origin. The sural nerve was electrically stimulated at the ankle level while BEPs were recorded monopolarly from the vertex. The stimulus intensity eliciting a liminal nociceptive reflex response in a knee-flexor muscle associated with a liminal pain was selected for this study. Both normal and affected side were alternatively stimulated during several conditions of controls and of Lasègue's manoeuvres performed on the normal and on the affected side. Results show that the Lasègue manoeuvre performed on the affected side induced a significant increase in the amplitude of N150-P220; performed on the normal side, this same manoeuvre resulted in a significant decrease of the N150-P220 amplitude. These variations were observed whatever was the side (normal or affected) under sural nerve stimulation. The possible neural mechanisms of these changes and clinical implications of these data are then discussed.

Afferent Pathways↗

PubMedDate not supplied

High resolution computed tomography in the diagnosis of laterally herniated lumbar discs.

Fourteen patients presenting with lumbar radiculopathy had normal or nondiagnostic plain radiographs, myelograms and polytomes of lumbar spine. The high resolution computed axial tomography (HR CAT) demonstrated laterally herniated discs in all cases. The CAT findings correlated well with the clinical presentations and were proven at surgery to be the cause of lumbar nerve entrapment. The preoperative accurate localization of the lesion resulted in complete postoperative relief of lumbar radiculopathy and back pain in 12 cases with two cases, though relieved of the radiculopathy, had residual mild nondisabling low back pain. In cases presenting with sciatica and having nondiagnostic myelograms and other conventional radiological studies, HR CAT of spine is the only reliable radiological test that can be used to rule out laterally herniated lumbar discs.

Adult↗

PubMed2005

Disc-like herniation in association with gas collection in the spinal canal: CT evaluation.

Gas production as a part of disk degeneration can occur but rarely causes nerve compression syndromes. Few cases have been reported in which lumbar intraspinal epidural gas cause nerve root compression symptoms. We present 12 cases of gas collection in the spinal canal that were presented to the orthopaedic out-patient department with symptoms of low back pain and sciatica. CT showed the presence of free epidural gas collections adjacent to or over the affected nerve roots. Relief of symptoms was noted with the change of positions, lying down or sleeping. In this study, we conclude that the presence of lumbar intraspinal epidural gas that causes radicular compressing phenomena, can be easily detected with the use of CT.

Adult↗

PubMed2005

Post-lumbar puncture arachnoiditis. The need for directed questioning.

The inflammation of the arachnoid mater may produce a fibrinous exudate around the roots that causes them to adhere to the dural sheath. We report the case of a man aged 23 years who suffered from acute inflammatory truncated sciatica. The diagnosis of adhesive arachnoiditis was made in front of clinical arguments associated to typical signs on Myelo CT Scan and MRI. The only explanation ever found was a traumatic lumbar puncture at the age of 6 years for suspected meningitis. Sequelae of arachnoiditis are difficult to diagnosis. When MRI or myelography suggests it as a possibility, precise directed questioning is necessary to seek a history, albeit distant, of spinal or meningeal events.

Adult↗

PubMed2006

Endoneural metastasis of the sciatic nerve disclosing the relapse of a renal carcinoma, four years after its surgical treatment.

METHODS: To report on an exceptional case of renal metastasis. Indeed, endoneural metastases of peripheral nerves are thought to be exceptional, and such an event has not yet been ascribed to a renal carcinoma. RESULTS: We report on a sciatica leading to the discovery of a tumour of the right thigh which proved to be an endoneural metastasis of the sciatic nerve from a renal carcinoma surgically removed 4 years before. CONCLUSION: A thorough palpation of peripheral nerve can help recognise such metastases in patients previously diagnosed with renal carcinoma.

Carcinoma, Renal Cell↗

PubMed2006

Hemangioblastoma of the filum terminale.

A 52-year-old man presented with low backache, paraesthesiae and spasticity of both lower limbs. He had urinary retention and constipation. Investigations revealed a vascular intradural cauda equina-conus tumor. MRI scan demonstrated an enhancing mass at the second and third lumbar vertebral levels. There were multiple dilated and tortuous veins draining from both poles of the tumor. Digital subtraction spinal angiogram showed the tumor to be supplied mainly by the radiculo-medullary artery from first lumbar artery and dural branches of the second and third lumbar arteries. At surgery, after pre-operative embolization, a well-defined tumor with an orange hue and fleshy consistency was encountered arising from the filum terminale. The tumor was excised en bloc. A sporadic hemangioblastoma arising from the filum terminale should be considered as a rare cause of back pain and sciatica. Total excision of the tumor offers cure.

Angiography↗

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