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At least 217 records · Page 12Linked to original sources

PubMed1995

Dorsal root ganglionectomy for intractable monoradicular sciatica. A series of 61 patients.

Dorsal root ganglionectomy was introduced in 1975 as a procedure with theoretical advantages over dorsal rhizotomy for the treatment of intractable radicular pain. Results of the few clinical reports have been generally favorable. The authors report the largest and most comprehensively studied series to date. 61 patients (33 men, 28 women) underwent dorsal root ganglionectomy for intractable sciatica, most often monoradicular. Patients were selected for surgery only if the clinical history, physical examination, radiologic studies, and diagnostic radicular block all predicted a favorable outcome. Sciatica was markedly reduced or eliminated in 36 patients (59%). Dysesthesia following ganglionectomy was observed frequently, but not invariably (approximately 60% of cases). Dysesthesia was generally of mild or moderate severity, self-limited, and responsive to treatment.

Adult↗

PubMed2002

Osteophyte at the sacroiliac joint as a cause of sciatica: a report of four cases.

Four cases of sciatica due to osteophytes impinging on the sciatic nerve at the sacroiliac joint are reported. Of these 4 cases, 2 were treated conservatively and the other 2 required surgical excision of the osteophyte. The report highlights the importance of keeping this uncommon etiology in the differential diagnosis of sciatica.

Adult↗

PubMed2003

Can quantitative sensory testing predict the outcome of epidural steroid injections in sciatica? A preliminary study.

Quantitative Sensory Testing (QST) is a psycho-physiological test used to identify dysfunction of individual nerve fiber types. In the present study, we investigated whether selective nerve fiber dysfunction, as assessed by QST, correlates with the effectiveness of epidural steroid injections (ESI) in patients with lumbar radiculopathy. Twenty patients with unilateral painful sciatica caused by disc herniation participated in this open study. Before ESI, quantitative thermal and mechanical sensory testing was conducted at the most painful dermatome and the contralateral dermatome. The primary outcome measure used was the self-recording of pain intensity twice daily with a 0-10 numerical pain scale (NPS). Secondary efficacy measures included the Short Form of the McGill Pain Questionnaire, the straight leg raising test, and the lumbar range of motion. A significant difference in all types of sensory thresholds between the affected and the contralateral dermatomes was detected at baseline. All outcome measures improved subsequent to the ESI. A significant positive correlation was found between the increase in cold sensation thresholds of the affected dermatome (Adelta-fiber dysfunction) and the improvement in NPS. The increase in touch and vibration thresholds (Abeta-fiber dysfunction) was found to be inversely correlated with the improvement in NPS. No correlation was found between heat sensation thresholds (C fibers) and any of the outcome measures. These results suggest that QST has the potential to be an important tool in the selection of the appropriate treatment (e.g., ESI versus surgery) for patients with sciatica and may assist in identifying the mechanisms of pain generation in these patients.

Adolescent↗

PubMed1987

Sciatica and epidural gas.

Epidural gas in the patient with sciatica can sometimes provide a clue that there is a surgically treatable lesion. Our patient had the sudden onset of sciatica at night, which was relieved by walking. An intraspinal synovial cyst was associated with epidural gas.

Aged↗

PubMed2005

Prolapsed intervertebral disc with sciatica: the role of common peroneal nerve block.

A total of 210 patients of Lumbar disc prolapse with sciatica were given common peroneal block by infiltrating 2% xylocaine around the common peroneal nerve 3 cm below the head of fibula on the affected side. After receiving the block the pain decreased on from grade 2.99 +/- 0.46 to 0.91 +/- 0.99, and straight leg raising increased from 32.1 +/- 12.55 to 59.66 +/- 12.11 degrees. The method, as an outpatient procedure, has been found to be simple and useful in the patients of sciatica with prolapsed lumbar intervertebral disc potentially appropriate for a low-resource setting.

Adolescent↗

PubMedDate not supplied

[Proposition of an anatomic and functional reserve into the spinal canal, as an interference factor on the mechanical degenerative low back pain and sciatica physiopathology].

OBJECTIVE: To test the hypothesis of an anatomic and functional reserve in the spinal canal that explains the radiological changes in lumbar spine of asymptomatic individuals, the differences in modalities of clinical presentation and the discrepancies in the prevalence of mechanical and degenerative low back pain and sciaticas. CASES AND METHODS: Two groups of 27 persons were submitted to computed axial tomography. In one group, the patients presented low back pain and/or sciaticas. The other formed by matched controls, showed no signs or symptoms. The bony canal area, dural sac area, interfacets distance and lateral recesses depth were quantitative assessed. RESULTS: The asymptomatics ones had larger bony canals than the acute and chronic patients, due to statistical significant differences. The ranges responsible for these differences and whose averages had higher figures in the asymptomatics ones in relation to the chronic patients, were the bony canal areas at L3-L4, L4-L5, the dural sac area and lateral recesses depth at L4-L5; in relation to acute ones: the bony canal areas at L3-L4, L4-L5, L5-S1, dural sac area at L4-L5, L5-S1, and sagittal diameter L5-S1 and lateral recesses depth at L4-L5. CONCLUSIONS: The radiological changes in asymptomatic ones, the lack of symptoms in the control group, the presence of chronic and acute features and the discrepancies in the prevalence of low back pain were attributed to the existence of an anatomic and functional reserve. This reserve would be determined by the presence of a "safety factor" which would have differential distribution in asymptomatics, acute and chronic. It would be the element able to influence the presence or absence of low back pain in persons with radiological changes.

Analysis of Variance↗

PubMed1988

Chemonucleolysis for sciatica. A critical review.

Intradiscal injection of chymopapain for the treatment of sciatica due to disc herniation has been used for more than 25 years, but is still under debate. We review the indications, complications, and clinical results, and discuss the tissue effects of chymopapain. The results following surgical disc removal versus chymopapain injection indicate that surgery with removal of the disc hernia through a small laminotomy remains the documented treatment of choice for patients with proven disc herniation and sciatica in whom conservative treatment has failed.

Chymopapain↗

PubMed2000

Pathoanatomy of clinical findings in patients with sciatica: a magnetic resonance imaging study.

OBJECT: Anatomical details of nerve root compression may explain the production of the signs and symptoms of sciatica. The authors of anatomical studies have offered many theories without clearly demonstrating the clinical relevance of the observations. Clinicoanatomical series are scarce and are affected to a great extent by selection bias. METHODS: The authors created a schematic drawing of the lumbar anatomy based on both the literature and in vitro anatomical observations. A diagnosis was then made with the aid of detailed and standardized clinical and magnetic resonance (MR) imaging studies in primary-care patients who presented with pain that radiated into the leg. Clinical and MR imaging findings were correlated. Finally, the anatomical drawing was compared with the clinical data. The higher the vertebral level of symptomatic disc herniations, the more likely the compression will be more laterally situated. Classic symptoms of sciatica (typically, dermatomal pain; increase in pain when coughing, sneezing, or straining; and testing positive for pain during straight leg raising) were most likely to occur with compression of the nerve root in the axilla and with mediolateral disc herniations. CONCLUSIONS: The L-3, L-4, L-5, and S-1 nerve roots each tend to be compressed at different sites along the rostrocaudal course of the nerve root. Disc herniations become symptomatic at different sites for each disc level. The schematic drawing produced a priori could well be used to explain these findings. Expectations of particular clinical findings can be predicted by specific pathoanatomical findings.

Adult↗

PubMed2005

Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment.

OBJECT: Because lumbar magnetic resonance (MR) imaging fails to identify a treatable cause of chronic sciatica in nearly 1 million patients annually, the authors conducted MR neurography and interventional MR imaging in 239 consecutive patients with sciatica in whom standard diagnosis and treatment failed to effect improvement. METHODS: After performing MR neurography and interventional MR imaging, the final rediagnoses included the following: piriformis syndrome (67.8%), distal foraminal nerve root entrapment (6%), ischial tunnel syndrome (4.7%), discogenic pain with referred leg pain (3.4%), pudendal nerve entrapment with referred pain (3%), distal sciatic entrapment (2.1%), sciatic tumor (1.7%), lumbosacral plexus entrapment (1.3%), unappreciated lateral disc herniation (1.3%), nerve root injury due to spinal surgery (1.3%), inadequate spinal nerve root decompression (0.8%), lumbar stenosis (0.8%), sacroiliac joint inflammation (0.8%), lumbosacral plexus tumor (0.4%), sacral fracture (0.4%), and no diagnosis (4.2%). Open MR-guided Marcaine injection into the piriformis muscle produced the following results: no response (15.7%), relief of greater than 8 months (14.9%), relief lasting 2 to 4 months with continuing relief after second injection (7.5%), relief for 2 to 4 months with subsequent recurrence (36.6%), and relief for 1 to 14 days with full recurrence (25.4%). Piriformis surgery (62 operations; 3-cm incision, transgluteal approach, 55% outpatient; 40% with local or epidural anesthesia) resulted in excellent outcome in 58.5%, good outcome in 22.6%, limited benefit in 13.2%, no benefit in 3.8%, and worsened symptoms in 1.9%. CONCLUSIONS: This Class A quality evaluation of MR neurography's diagnostic efficacy revealed that piriformis muscle asymmetry and sciatic nerve hyperintensity at the sciatic notch exhibited a 93% specificity and 64% sensitivity in distinguishing patients with piriformis syndrome from those without who had similar symptoms (p < 0.01). Evaluation of the nerve beyond the proximal foramen provided eight additional diagnostic categories affecting 96% of these patients. More than 80% of the population good or excellent functional outcome was achieved.

Adult↗

PubMed1999

Efficacy of epidural steroids in low back pain and sciatica. A critical appraisal by a French Task Force of randomized trials. Critical Analysis Group of the French Society for Rheumatology.

OBJECTIVE: Several randomized trials have suggested recently that epidural steroid injections may not be a valid treatment in common low back pain and sciatica. To clarify this issue, we conducted a critical appraisal of relevant randomized trials published up to 1997. Attention was directed to methodological quality, results, and clinical implications. METHOD: A Medline search identified 13 trials published between 1966 and 1997. Trial methodology was evaluated using a 100-point grid based on four groups of items, namely study population, therapeutic intervention, evaluation method, and data presentation and analysis. RESULTS: Methodology quality scores ranged from 12 to 84 and were unrelated to the results of epidural steroid therapy. Five trials demonstrated greater pain relief within the first month in the steroid group as compared to the control group. Eight trials found no measurable benefits. Obstacles to meaningful comparisons across studies included differences in the patient populations, steroid used, volume injected, and number of injections. None of the published studies used the injection modalities that are standard practice in France. CONCLUSION: Whether epidural steroids are effective in common low back pain and sciatica cannot be determined based on our review.

Evaluation Studies as Topic↗

PubMed2000

Efficacy of nerve root versus interspinous injections of glucocorticoids in the treatment of disk-related sciatica. A pilot, prospective, randomized, double-blind study.

STUDY OBJECTIVES: Pilot study comparing the short-term efficacy on pain and functional impairment of nerve root sheath versus interspinous glucocorticoid injections in patients admitted to a French rheumatology department for disk-related sciatica or femoral neuralgia. PATIENTS AND METHODS: Thirty patients with refractory nerve root pain (sciatica, n = 29; femoral neuralgia, n = 1) for a mean of four months were randomized to nerve root injection (n = 17) or interspinous injection (n = 13) of the same mixture of 0.10 g of lidocaine hydrochloride and 3.75 mg of cortivazol. Both injection methods were performed under analgesia and benzodiazepine sedation to maintain double blinding. Each patient was evaluated daily during the first seven days of bed rest in the hospital, then after discharge on postinjection day 28. RESULTS: Prompt pain relief was obtained in both groups. On day 1, the mean pain scale score (0-100) fell from 70 +/- 3.9 to 26 +/- 5.6 in the nerve root group and from 63 +/- 4 to 23 +/- 4.7 in the interspinous group. These results were sustained on D7 and D28. CONCLUSIONS: The unusually high level of efficacy of glucocorticoid injection in our study may be ascribable in part to strong placebo and Hawthorne effects and in part to the intrinsic effects of the injections. Whether nerve root injection is superior over interspinous injection remains unproven.

Adult↗

PubMed1975

Adhesive lesions of the nerve root in the dural orifice as a cause of sciatica.

The cause of sciatica is elusive in some cases. In a few instances it is due to the development of adhesions about the nerve root at the point of its entrance into the dural sleeve. Seven patients with sciatica in whom surgical exploration disclosed no evidence of a herniated intervertebral disc or other extradural pathology were found to have such involvement of the L5 or S1 root at the dural orifice inside the dural sac. This condition occurred in partial form in two cases and with total incarceration in five. Relief followed radicolysis and partial or total radicotomy.

Adult↗

PubMed2001

Sensory nerve somatosensory evoked potentials as add-on diagnostic procedure to imaging procedures in patients with sciatica.

The aim of the present study was to evaluate the ability of sensory nerve somatosensory evoked potentials (SEP) to discriminate between lumbar spine computed tomography (CT) findings with and without relevance for the radiating sensory symptoms in patients with sciatica in whom myelography does not have such discriminatory capacity. Forty consecutive sciatic patients in whom CT without intrathecal contrast showed degenerative changes which did not cause probable compression in at least one symptomatic nerve root, or caused probable compression in at least one asymptomatic nerve root, and in whom there were corresponding discrepancies between the radiating sensory symptoms and myelographic nerve root compression, were studied. Sensory nerve SEP representing nerve roots L4, L5 and S1, were performed in all patients. The sensory nerve conduction velocity (SNCV) and the amplitude of the sensory nerve action potential (SNAP) were recorded from the stimulated nerves. The odds ratios (OR 95% CI) of the association of positive SEP to symptomatic nerve roots were 24.0 (4.8 to 54.5) in nerve roots with probable and 39.0 (5.9 to 258.9) with possible CT compression. The corresponding associations between myelography and sciatic symptoms were not statistically significant. Comparisons of SNCVs and SNAP amplitudes did not indicate that postganglionic nerve dysfunction contributed to the sensory symptoms or to the SEP results. SEP examination may be used to discriminate between CT findings with and without relevance to the radiating sensory symptoms in patients with sciatica in whom myelography does not show this discriminatory capacity.

Adolescent↗

PubMed1992

[Persistent pain following discal sciatica: reflex sympathetic dystrophy, an unusual complication to be examined. Apropos of 4 cases].

Four patients who developed unilateral reflex sympathetic dystrophy of a lower limb associated with a bout of sciatica due to lumbar disc herniation are reported herein. In two cases, reflex sympathetic dystrophy developed after resolution of the sciatica, whereas the two conditions were concomitant in the two other patients. In all four patients, the diagnosis of reflex sympathetic dystrophy was missed. Surgery to release the root was considered in two cases. The reflex sympathetic dystrophy resolved within 1 to 3 months in every case. In view of the incidences of these two conditions, their concomitant occurrence seems rare. To avoid unwarranted therapeutic procedures, reflex sympathetic dystrophy should be considered in patients with chronic painful manifestations accompanying root involvement.

Adult↗

PubMed1992

Sciatica caused by piriformis muscle syndrome: report of two cases.

The diagnosis of piriformis muscle syndrome, an unusual cause of sciatica, is difficult. However, with the advancement of imaging techniques, it has become clear that the condition is not just clinical speculation, but is a definite entity. We report on two cases with piriformis muscle syndrome, diagnosed on the basis of: a history of sciatica; physical findings, such as a tender point at the sciatic notch and around the piriformis muscle by palpation of the gluteal region, and by a digital pelvic examination; and computed tomography (CT) to demonstrate hypertrophy of the piriformis muscle. In both cases, a tenotomy of the piriformis muscle at the greater trochanter relieved entrapment of the sciatic nerve and gave satisfactory results. Since local tenderness at the piriformis muscle is the most reliable physical finding, a pelvic examination is recommended in the evaluation of suspected cases of piriformis muscle syndrome. CT is helpful in showing hypertrophy of the piriformis muscle. Detailed history taking, a careful physical examination, and versatile use of CT or magnetic resonance imaging can lead to an early, accurate diagnosis and proper treatment.

Adult↗

PubMed1992

[Sciatica or herniated disk].

Lumbar radiculalgia may be due, beside the disc-nerve root conflict, to stenosis of osteoarticular canals, wide dural sac, epidural lipomatosis, segmental arachnoiditis, malignant or benign tumours and meningoradiculitis. Extraspinal truncular or radicular sciatica is usually due to compression by an expansive process. Some types of pain referred from articular structures may mimic sciatica.

Back Pain↗

PubMed2004

[Efficacy of tumor necrosis factor-alpha blockade for severe sciatica?].

The domain of sciatica is at the edge of a mini revolution. For ten years evidence have been accumulating in favour of a local inflammation rather than a pathology resulling only from a nerve compression. This hypothesis has first been strengthened by the discovery of inflammatory mediators in human herniated discs and then by animal models. These models have demonstrated the impossibility for nerve root compression to produce sciatica in the absence of inflammation and the importance of proinflammatory cytokines in this pathology. TNF-alpha have been proved to be the most important inflammatory cytokine and TNF-alpha modulators has been most effective in the treatment of these models. Two pilot studies realized on humans seem to confirm these experimental data. A multicenter randomised, double-blind, placebo controlled study is being planed in Switzerland.

Antibodies, Monoclonal↗

PubMed2004

Greater trochanter bursitis pain syndrome in females with chronic low back pain and sciatica.

Trochanteric bursitis is a clinical condition which simulates major hip diseases and low back pain, it may also mimic nerve root pressure syndrome. Patients with greater trochanteric bursitis pain syndrome (GTBPS) usually suffer from pain radiating to the posterolateral aspect of the thigh, paraesthesiae in the legs, and tenderness over the iliotibial tract.. The purpose of this study is to indicate the similarity between the clinical features of the GTBPS and those of chronic low back pain, and to highlight the importance of diagnosing GTBPS in patients complaining of low back conditions. Three hundred female patients were included in this prospective study. All patients complained about chronic low back pain or sciatica and had a failed long term conservative treatment. Local injection of the tender peritrochanteric area was only done in half of the patients (group 1). Patients were required to answer the Oswestry Disability Index Questionnaire during all periods of follow-up. Patients of group 1 had a better clinical outcome (p < 0.0005) than the patients in group 2 where no injection was done. We conclude that greater trochanter bursitis pain syndrome is a frequent syndrome which may be associated with low back symptoms. Patients with a long standing history of low back pain and sciatica should be routinely checked for GTBPS. GTBPS is easy to diagnose and can be treated. Peritrochanteric infiltration with glucocorticoids mixed with 2% lidocaine relieves patients from their symptoms for a long period of time. Recurrence should always be expected, but treatment may be repeated.

Activities of Daily Living↗