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Symptoms and signs of sciatica and their relation to the localization of the lumbar disc herniation.

Neurologic symptoms and signs in patients with sciatica were prospectively studied and compared with myelographic and operative findings in 403 cases with lumbar disc herniation as the cause of sciatica with special reference to accuracy of the clinical level diagnosis. Fifty-six percent of the herniations at L4-5. However, pain projection into the first sacral distribution was most common. Neurologic symptoms and signs of involvement of a single root were present in 239 cases and of two roots in 154 cases in L4-5 and L5S1 herniations. Pain projection into the fifth lumbar distribution was a very important symptom for identification of clinical findings of the fifth lumbar root involvement gave a level diagnostic accuracy comparable with myelography, while pain projection into the first sacral distribution was less reliable especially in cases with signs of two roots. The neurologic picture of high herniations was completely unreliable. Lumbar myelography or computer tomography is recommended as a routine preoperative study.

Adult↗

PubMed1988

Safety and efficacy of chymopapain (Discase) in the treatment of sciatica due to a herniated nucleus pulposus. Results of a randomized, double-blind study.

A prospective, multiinstitutional, double-blind trial comparing the effect of chymopapain (Discase) vs. placebo (cysteine-edetate-iothalamate: CEI) for lumbar intervertebral disc rupture with sciatica was carried out on 173 patients, the largest such study reported to date. Patients were matched with respect to age, sex, physical habitus, and level of injection. The procedure was carried out under local anaesthesia. The success rate was superior in the chymopapain group regardless of the method used to assess outcome or the time over the first 6 months at which the two groups were compared: 71% vs. 45% if code breaks were analyzed at 6 months, and 67% vs. 44% if code breaks were defined as lost to follow-up. A single case of anaphylaxis and one case of septic discitis were the only serious complications noted. This study supports the role of chymopapain in the treatment of lumbar disc rupture with sciatica.

Adolescent↗

PubMed1995

Gastrocnemius muscle herniation at the knee causing peroneal nerve compression resembling sciatica.

STUDY DESIGN: This was a case report. OBJECTIVES: This is a case report of common peroneal nerve compression resembling sciatica caused by muscle herniation through the gastrocnemius muscle fascia in the popliteal area. SUMMARY OF BACKGROUND DATA: A review of the literature revealed various causes of nerve compression of the lower extremity that resembles symptoms of sciatica (pseudoradiculopathy). There is, however, no report of pseudoradiculopathy caused by gastrocnemius muscle herniation in the popliteal area. METHODS: The diagnosis of muscle herniation was confirmed during an exploratory operation of the common peroneal nerve in the popliteal area after other possible causes for L5 radiculopathy such as disc herniation and nerve root compression in the lumbar spine were ruled out by various imaging tests. RESULTS: Complete relief of symptoms was obtained after the torn gastrocnemius fascia was repaired. CONCLUSION: An unusual case of pseudoradicular symptoms is presented caused by compression of the common peroneal nerve in the popliteal area by gastrocnemius muscle herniation.

Adult↗

PubMed1997

P1-latency interroot comparison enhances the validity of scalp-recorded somatosensory-evoked potentials to diagnose nerve root dysfunction in sciatica.

STUDY DESIGN: A prospective validity study was done of scalp-recorded somatosensory-evoked potentials as a diagnostic procedure to show lumbosacral radiculopathy in 100 consecutive patients with unilateral or bilateral sciatica. OBJECTIVE: To determine the validity gained by the use of P1-latency interroot comparison to show P1-latency prolongation. SUMMARY OF THE BACKGROUND DATA: The validity of scalp-recorded somatosensory-evoked potentials in diagnosing lumbosacral radiculopathy has been debated and is uncertain. METHOD: Sensory nerves representing nerve roots L4, L5, and S1 were stimulated bilaterally. Height-corrected P1-latency, two new P1-interroot comparison-based criteria, and absence of P1 were studied. The gold standard was defined as clinically-involved nerve roots with radiologic nerve root compression. The false-positive nerve root compression rate was determined, and the gold standard was corrected accordingly. Clinically relevant cut-off values were defined by multilevel likelihood ratio analysis. RESULTS: The positive and negative likelihood ratios of P1-latency prolongation were 6.79 and 0.53, respectively, for the gold standard, and 10.57 and 0.21, respectively, for the corrected gold standard. The validity was not reduced when scalp-recorded, somatosensory-evoked potentials were blinded to the radiologic results. Absence of P1 was associated to the gold standard and the corrected gold standard. Compared with the combined use of P1-latency interside difference and height-corrected latency, the combination of P1-interroot comparison and height-corrected P1-latency increased the sensitivity by 20% for the gold standard and 32% for the corrected gold standard, and when absent P1 was added, the overall sensitivity was 53% for the gold standard and 81% for the corrected gold standard. The corresponding specificity was 92%, and in asymptomatic nerve roots it was 98%. CONCLUSION: The P1-interroot comparison permits the use of scalp-recorded somatosensory-evoked potentials as a contributory "rule in" procedure in patients with sciatica.

Adolescent↗

PubMed1997

Nuclear magnetic resonance spectroscopy of cerebrospinal fluid from patients with low back pain and sciatica.

STUDY DESIGN: This study was carried out to assess the metabolic differences between pain-free control subjects and patients with low back pain, either with or without disc protrusion or herniation. OBJECTIVES: To analyze various metabolites in human cerebrospinal fluid using proton nuclear magnetic resonance spectroscopy. The potential use of this technique as an additional tool for diagnostic assessment was also evaluated. SUMMARY OF BACKGROUND DATA: Inflammation is thought to play a major role in the generation of lumbar spine pain, a theory supported both by animal and in vitro studies. The effect of the inflammation in terms of increased metabolism has not yet been studied. METHODS: Cerebrospinal fluid was obtained from patients by lumbar puncture, frozen, redissolved, and analyzed for metabolites by proton nuclear magnetic resonance spectroscopy. RESULTS: Significantly lower values for several key metabolites were found in patients with low back pain or sciatica, with the lowest values in the subgroup of patients with myelographic signs of disc protrusion or herniation. CONCLUSIONS: The results indicate a higher level of metabolic activity in patients with low back pain or sciatica compared with pain-free control subjects, with this difference being most pronounced in the subgroup of patients with myelographic evidence of disc protrusion or herniation.

Adult↗

PubMed1997

Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication.

STUDY DESIGN: In patients with sciatica or neurogenic claudication, the structures in and adjacent to the lumbar spinal canal were observed by computed tomographic myelography or magnetic resonance imaging in psoas-relaxed position and during axial compression in slight extension of the lumbar spine. OBJECTIVES: To determine the mechanical effects on the lumbar spinal canal in a simulated upright position. SUMMARY OF BACKGROUND DATA: For years, functional myelographic investigation techniques were shown to be of value in the evaluation of suspected encroachment of the spinal canal. Since the advent of computed tomography and magnetic resonance imaging, there have been few clinical and experimental attempts that have imitated these techniques. The data indicate that the space within the canal is posture dependent. METHODS: Portable devices for axial loading of the lumbar spine in computed tomographic and magnetic resonance examinations were developed. Fifty patients (94 sites) were studied with computed tomographic myelography, and 34 patients (80 sites) with magnetic resonance in psoas-relaxed position followed by axial compression in slight extension. The dural sac cross-sectional area at L2 to S1, the deformation of the dural sac and the nerve roots, and the changes of the tissues surrounding the canal were observed. RESULTS: In 66 of the investigated 84 patients, there was a statistically significant reduction of the dural sac cross-sectional area in at least one site during axial compression in slight extension. Of the investigated patients, 29 passed the borderlines for relative (100 mm2) or absolute stenosis (75 mm2) in 40 sites. In 30 patients, there was deformation of the dural sac in 46 sites. In 11 of the patients investigated with magnetic resonance imaging, there was a narrowing of the lateral recess in 13 sites, during axial compression in slight extension. CONCLUSIONS: Axial loading of the lumbar spine in computed tomographic scanning and magnetic resonance imaging is recommended in patients with sciatica or neurogenic claudication when the dural sac cross-sectional area at any disc location is below 130 mm2 in conventional psoas-relaxed position and when there is a suspected narrowing of the dural sac or the nerve roots, especially in the ventrolateral part of the spinal canal in psoas-relaxed position. The diagnostic specificity of the spinal stenosis will increase considerably when the patient is subjected to an axial load.

Adult↗

PubMed2000

Appropriateness of surgery for sciatica: reliability of guidelines from expert panels.

STUDY DESIGN: Reliability study of guidelines development. OBJECTIVE: To compare criteria for low back surgery between two expert panels. BACKGROUND: Reliability of expert panels for determining appropriateness of indications for surgical procedures has heretofore received little attention. METHODS: Two multidisciplinary expert panels of similar composition were convened, in the United States and in Switzerland, to evaluate the appropriateness of 720 distinct clinical scenarios involving sciatica. Each indication was assigned to a category of appropriate, uncertain, and inappropriate. The appropriateness of the 720 theoretical scenarios were compared between the two panels, and both sets of criteria were applied to two series of actual cases. RESULTS: Seventy-nine percent (n = 566) of the 720 theoretical indications were assigned to identical categories of appropriateness by both panels (kappa = 0.63; P < 0.001). Only 2 of the 720 scenarios elicited frank disagreement. The percentage of the 720 indications that were considered appropriate differed between the two panels (U.S.: 3%; Swiss: 11%, P < 0.001), as did the percentage of intrapanel agreement for indications (U.S.: 51%, Swiss: 64%, P < 0.001). When the same theoretical scenarios were matched with two series of actual cases (n = 181 and 149) agreement was moderate (kappa = 0.46) to fair (kappa = 0.30). CONCLUSION: There was substantial agreement on the appropriateness of surgery for theoretical cases of sciatica between independent expert panels from two countries. A better understanding of discordant ratings, especially for actual cases, should precede attempts at transposing recommendations emanating from a panel in one country to another.

Expert Testimony↗

PubMed2001

Cost effectiveness of periradicular infiltration for sciatica: subgroup analysis of a randomized controlled trial.

STUDY DESIGN: A subgroup analysis of a prospective, randomized controlled trial was performed. OBJECTIVE: To describe the cost effectiveness of periradicular infiltration with steroid in subgroups of patients with sciatica. SUMMARY OF BACKGROUND DATA: A recent trial on periradicular infiltration indicated that a methylprednisolone-bupivacaine combination had a short-term effect, as compared with that of saline. This report describes the efficacy and cost effectiveness of steroid in subgroups of patients with sciatic. METHODS: This study involved 160 patients with unilateral sciatica. Outcome assessments were leg pain (100-mm visual analog scale), disability on the Oswestry Low Back Disability Questionnaire, and the Nottingham Health Profile. Data on medical costs and sick leaves also were gathered. Patients were randomized for periradicular infiltration with either methylprednisolone-bupivacaine or saline. The adjusted between-group treatment differences at each follow-up assessment, the number of patients free of leg pain (responders, cutoff 75%), and efficacy by the area-under-the-curve method were calculated. For the cost-effectiveness estimate, the total costs were divided by the number of responders. The rate of operations in different subgroups was evaluated by Kaplan-Meier analysis. RESULTS: In the case of contained herniations, the steroid injection produced significant treatment effects and short-term efficacy in leg pain and in Nottingham Health Profile emotional reactions. For symptomatic lesions at L3-L4-L5, steroid was superior to saline for leg pain, disability, and straight leg raising in the short term. By 1 year, steroid seemed to have prevented operations for contained herniations, costing $12,666 less per responder in the steroid group (P < 0.01). For extrusions, steroid seemed to increase the operation rate, and the steroid infiltration was more expensive, costing $4445 per responder (P < 0.01). CONCLUSIONS: In addition to short-term effectiveness for contained herniations and lesions at L3-L4-L5, steroid treatment also prevented surgery for contained herniations. However, steroid was countereffective for extrusions. The results of the subgroup analyses call for a verification study.

Adult↗

PubMed2003

The Maine-Seattle back questionnaire: a 12-item disability questionnaire for evaluating patients with lumbar sciatica or stenosis: results of a derivation and validation cohort analysis.

STUDY DESIGN: Analysis of health-related quality of life data obtained from a prospective cohort study of patients with sciatica due to an intervertebral disc herniation or lumbar spinal stenosis. OBJECTIVE: To derive and validate a shortened version of a previously validated 23-item modification of the Roland-Morris Disability Questionnaire. SUMMARY OF BACKGROUND DATA: For patients with low back pain, improving health-related quality of life is often the main goal of therapy. The Roland-Morris Disability Questionnaire is one of the best validated and most frequently used back-specific functional status measures. A shortened version may permit more widespread use in clinical and research settings. METHODS: Data from 507 patients with sciatica enrolled in the Maine Lumbar Spine Study were used to derive a shortened version of a 23-item modification of the original Roland-Morris Disability Questionnaire using qualitative and cluster analysis techniques. The internal consistency, construct validity, reproducibility, and responsiveness in detecting change over a 3-month period for a new 12-item scale was compared to the original 23-item scale. The 12-item scale was then validated in an independent cohort of 148 patients with lumbar spinal stenosis. RESULTS: Internal consistency was very good but modestly lower for the 12-item instrument compared to the 23-item original scale. Reproducibility over a 3-month interval was good and did not differ between the 12-item and original scale. Findings from the validation cohort were similar or better than the derivation cohort. A high degree of construct validity with patient-reported symptoms was demonstrated for the 12-item and original scales. The responsiveness and interpretability of the 12-item scale over 3 months was excellent and comparable to the original scale. Responsiveness assessed in patients with lumbar spinal stenosis in the independent validation cohort showed consistent findings compared to patients with a disc herniation in the derivation cohort. CONCLUSIONS: This short, simple, self-administered 12-item back-specific functional status questionnaire performed extremely well in comparison with the original 23-item scale. If validated in additional study populations, this new questionnaire may be useful in the clinical setting as a way for providers to prospectively compare their outcomes of care to other patient populations, and to study treatment effectiveness.

Adult↗

PubMed2004

Three-year follow-up of lumbar artery occlusion with magnetic resonance angiography in patients with sciatica: associations between occlusion and patient-reported symptoms.

STUDY DESIGN: Comparison of occlusion of lumbar arteries in magnetic resonance angiography (MRA) with patient-reported sciatica symptoms during a 3-year follow-up. OBJECTIVES: To evaluate whether occlusion of lumbar arteries is associated with subjective pain symptoms and physical ability among sciatica patients. SUMMARY OF BACKGROUND DATA: Cadaveric studies indicate that atherosclerotic manifestations of the abdominal aorta are associated with low back pain (LBP). Impaired blood flow may disturb diffusion of nutrients into the disc, causing degeneration and possibly back pain. METHODS: Two-dimensional time-of-flight MRA was used to evaluate lumbar arteries at baseline and 3 years. The arteries on both sides (L1-L4) were evaluated visually and scored as normal, narrowed, or occluded. Incidence of new stenosis was estimated. The associations of stenosis with self-reported previous medical consultations, pain duration through the first year, and number of pain episodes through the last 2 years of follow-up were calculated. Additionally, leg and back pain (10-cm VAS), disability (Oswestry), and self-reported physical ability (self-efficacy) were inquired at 1, 2, and 3 years. In the statistical analysis, bivariate correlation, and the chi or Fisher's test were used. RESULTS: MRA was obtained at baseline for 147 patients and at 3 years for 134 patients. Baseline stenosis associated with intensity of back pain at 1 year, leg pain at 2 years, and self-efficacy at every follow-up assessment, but not with disability, previous LBP history, or future pain episodes. The associations of stenosis at 3 years were similar but weaker. Newly formed stenosis was associated with the preceding year's medical consultations due to LBP and prolonged LBP during the first follow-up year. CONCLUSIONS: Arterial stenosis is associated strongly and consistently with patient-estimated physical ability,but only slightly with subjective pain symptoms. Interestingly, new stenosis is preceded by pain symptoms. The evaluation of lumbar blood flow may thus be useful in clinical practice.

Adult↗

PubMed2005

The updated cochrane review of bed rest for low back pain and sciatica.

STUDY DESIGN: A systematic review within the Cochrane Collaboration Back Review Group. OBJECTIVES: To report the main results from the updated version of the Cochrane Review on bed rest for low back pain. SUMMARY OF BACKGROUND DATA: There has been a growing amount of evidence showing that bed rest is not beneficial for people with low back pain. However, existing systematic reviews are unclear regarding the effects of bed rest for different types of low back pain. METHODS: All randomized studies available in systematic searches up to March 2003 were included. Two reviewers independently selected trials for inclusion assessed the validity of included trials and extracted data. Investigators were contacted to obtain missing information. RESULTS: Two new trials comparing advice to rest in bed with advice to stay active were included. There is high quality evidence that people with acute low back pain who are advised to rest in bed have a little more pain (standardized mean difference 0.22, 95% confidence interval: 0.02-0.41) and a little less functional recovery (standardized mean difference 0.29, 95% confidence interval: 0.05-0.45) than those advised to stay active. For patients with sciatica, there is moderate quality evidence of little or no difference in pain (standardized mean difference -0.03, 95% confidence interval: -0.24-0.18) or functional status (standardized mean difference 0.19, 95% confidence interval: -0.02-0.41) between bed rest and staying active. CONCLUSION: For people with acute low back pain, advice to rest in bed is less effective than advice to stay active. For patients with sciatica, there is little or no difference between advice to rest in bed and advice to stay active.

Adolescent↗

PubMed2005

Prognosis or "curabo effect?": physician prediction and patient outcome of surgery for low back pain and sciatica.

STUDY DESIGN: Prospective study with patient and physician questionnaires, clinical records, and imaging. OBJECTIVE: To compare physician expectations of surgery for sciatica and patient outcome. SUMMARY OF BACKGROUND DATA: Physician accuracy in identifying individual patient prognosis is important for therapeutic decisions. METHODS: A total of 197 consecutive patients with low back pain and/or sciatica who underwent low back surgery in the University Hospital of Lausanne, Switzerland. RESULTS: Physicians predicted "a great improvement" of quality of life after surgery for 79% and "moderate improvement" for 20% (1% others); 39% of patients had no "minimal clinically important difference" in back pain after surgery, despite physician prediction of "great improvement." Correlations between physician expectation and various dimensions of patient outcome were not significant, and agreement with patient global judgment of 1-year outcome was poor (kappa = 0.03). However, in a subgroup where the indication for treatment was not considered appropriate, physician prediction of "great improvement" was followed by greater improvement outcome on SF-36 mental component score (P = 0.05), mental health (0.02), and general health (0.03) compared with patients where the physician did not predict "great improvement." CONCLUSION: Despite clear average improvement, surgeons tended to give overly optimistic predictions that were not correlated with patient outcome. For patients receiving a treatment not meeting explicit criteria of appropriateness, more optimistic physician expectation was associated with better improvement of psychological dimensions. Besides prognostic ability, the influence of physician expectation on patient outcome is discussed and the concept of "curabo effect" (differentiated from "placebo effect") proposed.

Adolescent↗

PubMed2006

Natural course of disc morphology in patients with sciatica: an MRI study using a standardized qualitative classification system.

STUDY DESIGN: A prospective observational study of patients with sciatica. OBJECTIVES: To describe the 14-month development of disc-related MRI findings in patients with sciatica receiving active conservative treatment. SUMMARY OF BACKGROUND DATA: Previous studies of disc changes over time have reported reduction of herniations in 35% to 100% of cases. This wide range may be explained by differences in patient populations and classifications used to describe disc herniations. METHODS: Data were obtained from patients with radicular pain (n = 181) who were randomly allocated into one of two active conservative treatment regimens lasting 8 weeks. All patients were scanned at baseline and at 14 months of follow-up. Variables of interest in the present study were disc contour and nerve root compromise at the presumed symptomatic disc level. Disc contour was assessed using the recommendations from the Combined Task Forces of NASS, ASSR, and ASNR. RESULTS: In all, 154 patients were included in this study (70 women and 84 men; range, 18-65 years; mean and median age, 45 years). It was possible to identify the symptomatic disc level in 90% of patients. Extrusions or sequestrations were more common in individuals younger than 45 years and in men. Men were also more likely to have nerve root compromise. Only 3% of bulges and 38% of focal protrusions improved, whereas 75% to 100% of broad-based protrusions, extrusions, and sequestrations improved (P < 0.0001). Nerve root compromise improved in 21% to 80% depending on the disc contour. Neither type of treatment nor age had any effect on the development of MRI findings over time. However, nerve root compromise was more likely to improve in men. CONCLUSIONS: This classification system could be used to identify the majority of symptomatic disc levels. At 14 months, the MRI outcome was generally good for disc herniations and nerve root compromise. Nerve root compromise had the best MRI prognosis if the disc was extruded at baseline. There were significant differences between men and women in relation to baseline findings as well as in relation to development of MRI findings over time.

Adult↗

PubMed1995

MRI of intraspinal nerve sheath tumours presenting with sciatica.

The magnetic resonance imaging (MRI) characteristics of 14 intraspinal nerve sheath tumours (NST) presenting with sciatica were reviewed. The group comprised seven schwannomas, six neurofibromas and one perineuroma. The tumours were either iso- or hypointense with respect to spinal cord on T1-weighted (T1W) images; almost all tumours were hyperintense compared with spinal cord on T2-weighted (T2W) images. The tumours were all detectable on unenhanced T1W images. Nine NST were scanned following Gadolinium-Diethylenetriamine penta acetic acid (DTPA) injection and all showed intense enhancement. This aids differentiation from sequestrated disc fragments. Tumours were more likely to show homogeneous enhancement unless they were recurrent tumours. Rim enhancement occurs more commonly in schwannomas and this can be used to differentiate these from neurofibromas. However, on unenhanced images, schwannomas cannot be distinguished from neurofibromas. Four tumours occurred at T11-T12. There was poor correlation of the site of the lesion with the clinical findings. MRI studies in patients with sciatica should include the lower thoracic region especially if no protruded disc was found in the lumbar region.

Adolescent↗

PubMed2005

Electroacupuncture direct to spinal nerves as an alternative to selective spinal nerve block in patients with radicular sciatica--a cohort study.

We applied electroacupuncture to the spinal nerve root by inserting needles under x ray imaging in three cases with radicular sciatica, as a non-pharmacological substitute for lumbar spinal nerve block. In all three cases, symptoms were markedly reduced immediately after electroacupuncture to the spinal nerve root. The sustained effect was noticeably longer than that of spinal nerve blocks previously performed, in two out of the three cases. We suggest that descending inhibitory control, inhibitory control at the spinal level, inhibition of potential activity by hyperpolarisation of nerve endings, or changes in nerve blood flow may be involved in the mechanism of the effect of electroacupuncture to the spinal nerve root. These results suggest that electroacupuncture to the spinal nerve root may be superior to lumbar spinal nerve block when it is applied appropriately in certain cases of radicular sciatica, taking into consideration patient age, severity of symptoms and duration of the disorder.

Aged↗

PubMed1998

Achilles tendon rupture and sciatica: a possible correlation.

The association between Achilles tendon rupture and sciatica was investigated by questionnaire in 138 patients who underwent repair of an Achilles tendon rupture, and in a group of individuals nominated by the patients, matched for age, sex, and occupation. A total of 102 patients (74%) and 128 peer nominated controls (71%) replied to the questionnaire. Of the 102 respondent patients, 18 had an officebased job, 47 were involved in skilled nonmanual work, and 16 were retired. Back pain had been experienced by 63 of the patients who replied to the questionnaire, and by 91 (75%) of the individuals in the control group (difference not significant). In about 30% of both groups, the pain confined them to bed for at least two days, and resulted in absence from work. Thirteen of the patients and 16 of the controls had undergone thoracic, lumbar, or sacral radiography. One individual in each group had received surgery for back pain. However, 35 of 102 patients had experienced sciatic pain before Achilles tendon rupture. Pain of a similar nature had been experienced by only 15 individuals in the control group (12%) (p < 0.001). Using this study design, we found a highly significant association between Achilles tendon rupture and sciatica. We propose that this association could be due to impaired afferent signals from the lower leg, or to similar collagen or vascular anomalies of the vertebral disc and the Achilles tendon.

Achilles Tendon↗

PubMed1980

Computed tomography in sciatica.

Lumber facet arthropathy and a herniated disk are two major causes of low back pain and sciatica. The authors evaluated the importance of computed tomography (CT) in 243 patients with low back pain and/or sciatica. Lumbar facet abnormalities were found in 139 patients (57%), and a herniated disk was found in 48 patients (20%). CT findings correlated precisely with surgical observations in cases involving a herniated disk and correlated well with the results of an intra-articular facet block in a small series of patients. CT can effectively diagnose and differentiate between lumbar facet arthropathy and a herniated disk.

Adult↗

PubMed1989

Recurrent postoperative sciatica: evaluation with MR imaging and enhanced CT.

Magnetic resonance (MR) imaging and computed tomography enhanced with intravenous iodine injection (ECT) were prospectively compared in 80 patients in the diagnosis of recurrent postoperative sciatica. Diagnostic accuracy was determined with surgical verification. Isolated fibrosis was considered a contraindication to surgery. A decision to operate was made in 56 of the 80 patients on the basis of MR imaging findings; in 21 of the 56, the decision was also made on the basis of ECT findings. Of the 80 patients, 45 underwent surgery, In all but one of these patients, the diagnosis made on the basis of MR imaging findings was confirmed with surgical analysis. The only surgical finding that did not agree with MR imaging findings was a calcification of the common posterior ligament. The 21 diagnoses of disk herniation based on ECT findings were confirmed surgically, but among the 24 diagnoses of fibrosis made with the help of ECT, there were actually 19 recurrent herniations, four herniations with fibrosis, and one herniation at the level above the previously resected disk. MR imaging seems to be the investigation of choice in diagnosing the cause of recurrent postoperative sciatica.

Adult↗