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PubMed1992

[Surgical treatment of radicular sciatica].

The surgical treatment of radicular sciaticas has to be fitted to the patient's mainly functional problem. In every case but the obviously surgical sciaticas due to tumor, surgery and percutaneous techniques must be discussed with regard to the anatomical factors participating in the root compression and the patient tolerance to his pain. The surgical approach is now limited but the disc removal must be extensive. Complications are very rare, especially infectious ones. Failures account for less than 10% in case of good indications and are related to recurrence of disc herniation and to so-called fibrosis. The operative results are to a large extent related to the patient's psychological profile and his active involvement in the treatment.

Humans↗

PubMed2005

[Effect of warming needle moxibustion on pain threshold in the patient of sciatica].

OBJECTIVE: To observe effect of warming needle moxibustion on pain threshold in the patient of sciatica. METHODS: Ninety cases were randomly divided into 3 groups, 30 cases in each group. The warming needle moxibustion group were treated with warming needle moxibustion at Shenshu (BL 23), Dachangshu (BL 25), Huantiao (GB 30), etc; the western medicine group with oral administration of Nimeisulide; and the acupoint-injection group with injection of 654-2 into the same acupoints as those in the warming needle moxibustion group. RESULTS: The cured rates were 56.67%, 26.67% and 20.00% in the 3 groups, and the total effective rate were 90.00%, 73.33% and 63.33%, respectively, the therapeutic effect of the warming needle moxibustion group being better than those of other two groups (both P < 0.01). The amplitude of pain threshold increase in the warming needle moxibustion group was higher than those of other two groups (both P < 0.01). CONCLUSION: Warming needle moxibustion can increase pain threshold, improve symptoms and raise quality of life for the patient of sciatica.

Humans↗

PubMedDate not supplied

Our experience with epidural steroid injections in management of low backpain and sciatica.

BACKGROUND: Low back pain and sciatica is a common clinical condition. It is a most common orthopaedic complaint in the Kaski region of Nepal. The reason for its increased incidence may be hilly terrain, difficult working and living environment of the region. The initial treatment of Low back pain is conservative. Epidural steroid injection is being slowly established as are liable mode of conservative management in many orthopaedic centres of the world. This is a preliminary report of on-going study of the use of epidural steroid in the management of low back pain cases coming to the orthopaedic department of Manipal Teaching Hospital. METHODS: Prospective clinical trial was carried out on the patients reporting with low back pain and sciatica not responding to other modes of conservative treatment. Pre and post injection evaluation was done clinically. The level of pain, improvement in physical signs and ability to do activities of daily living were noted. RESULTS: Fifty two patients were observed for the average duration of 2.87 months. Average duration of symptoms was for 10 months. After first epidural steroid injection 83% of patients reported relief on day one. In some cases the onset of analgesia was delayed. Four patients reported no relief after first injection. Fifteen patients were given two injections and four received three injections. The average duration between two injections was three weeks. Average duration of pain relief was 20 days. At the end of 3 months, good results were seen in 39%, fair in 33% and bad results in 27%. Overall 59% of patients were able to do activities of daily living. Three patients (5.76%)required operation for disc prolapse. Postoperatively two patients reported back with back pain. Most common complaint of patients after injection was pain at the injection site. No major complications were encountered. CONCLUSION: Epidural Steroid Injection is a safe and effective mode of treatment of Low Back Pain. It provides painfree period to enable the patient for physiotherapy which helps in early recovery.

Adult↗

PubMed1991

[Recurrent sciatica caused by "conjoined nerve roots". Diagnosis, therapy, follow-up].

This study reports about 10 patients, with low back pain and sciatica caused by conjoined nerve roots. The described nerve root anomaly could produce sciatica even without the presence of a disc prolaps or another impingement. On computed tomography it is difficult to distinguish conjoined nerve roots from a disc prolaps. Two of these patients have been operated, eight of them have had conservative treatment. Our experiences show that the best results could be achieved with conservative treatment, especially with stabilising gymnastics and with transcutaneous nerve stimulation.

Adult↗

PubMed1990

[A comparative study of myelography and CAT in patients with lumbo-sciatica].

One hundred patients with acute lumbo sciatica symptoms probably due to disc hernia, have been studied. A CT scan and a myelography was performed in all patients. The clinical and radiologic (myelography and CT scan) findings have been evaluated in three categories based on their intensity and a correlation between these three parameters has been performed. Our results show a positivity of 94% in the clinical signs, 87% in the myelography findings and 88% in CT scan findings. The correlation results show that in very severe lumbo sciatica syndromes there is a greater positivity in the myelography than in CT scan findings and that there could be big radiologic changes without a clear clinical repercussion.

Acute Disease↗

PubMed1990

Isthmic lumbar spondylolisthesis with sciatica. MR imaging vs myelography.

Seventeen patients with sciatica and isthmic lumbar spondylolisthesis were studied with magnetic resonance (MR) imaging. In 13, myelography was also performed: 5 had dural sac deformation and root sleeve shortening, 2 had deformation with unilateral root sleeve shortening, one had bilateral root sleeve shortening only, and one had sac deformation only. In 4, myelography was normal. On sagittal MR examinations the neural foramen had an altered shape bilaterally with the long axis horizontal in all cases. In addition to altered shape the following was found in the 33 foramina evaluated. I: normal nerve (n = 8); II: compressed nerve (n = 16); III: disappearance of fat, nerve not possible to identify (n = 9). In patients with unilateral sciatica, the degree of foraminal stenosis correlated well with the side of symptoms. Coronal views showed the course of the nerve and pedicular kinking. Eight patients underwent decompressive surgery which revealed nerve compression by hypertrophic fibrous tissue and pedicular kinking, which correlated well with the findings on MR. Since the site of nerve compression often was peripheral to the root sleeves, myelography did not give complete information.

Adult↗

PubMed1990

A prospective study of patients with sciatica. A comparison between conservatively treated patients and patients who have undergone operation, Part I: Patient characteristics and differences between groups.

Based on a prospective study on 342 sciatica patients examined with rhizography, the aim was to determine which factors others than the rhizography finding and the grade and duration of symptoms were related to the selection of patients to undergo operation. Compared with surgically treated patients, conservatively treated patients who did not undergo operation and who had pathologic rhizography findings had pessimistic attitudes to possible surgery, often expressed a desire to retire, and considered their work as physically stressful. The women in this group were older and had lower pain indices than women who underwent operation. Conservatively treated patients with negative rhizography had more severe occupational handicaps, minor expectations of possible surgery, physically more strenuous jobs requiring difficult physical positions, and lower indices for pain and ADL than did the operated patients. The social and ergonomic background problems are emphasized in sciatica patients conservatively treated after rhizography.

Adult↗

PubMed1989

Percutaneous posterolateral lumbar discectomy. An alternative to laminectomy in the treatment of backache and sciatica.

The evacuation and decompression of the herniated lumbar disc (HLD) through a sheath or cannula inserted dorsolaterally represent a new concept in the treatment of backache and sciatica associated with disc herniation. Under local anesthetic and Valium (Roche, Nutley, New Jersey) sedation, 20 patients with sciatica, restricted straight-leg raising, and neurological impairment were treated by this simple and safe technique. All patients had computed tomographic evidence of L4-L5 protrusion. The introduction of a sheath with an internal diameter of 4.9 mm permitted removal of the nuclear material by means of a small pituitary forcep. Using the self-assessment method of Coventry and Stauffer, it was concluded that 12 of the 20 patients had a good or fair result. Predictably, the compensation patients fared poorly. There were no complications. This technique appears applicable in HLD to properly selected patients, and it would seem that it is safe, effective, and cost efficient.

Adult↗

PubMed1989

Natchev's auto-traction for lumbago-sciatica: effectiveness in lumbar disc herniation.

In Lind's auto-traction (LAT) for lumbago-sciatica, the patient provides traction force by pulling with the arms on a specially designed table, which also allows painless mobilization of the lumbar spine and passive traction. Two studies reported that one to 15 one-hour sessions on successive days might be sufficient to relieve pain in 25% to 90% of cases with verified lumbar disc herniation. Unfortunately, the technique imposes tiring manual efforts on the therapist and requires that the patient be transported by ambulance and confined to bed for a long time. These inconveniences were removed in a new version of the treatment proposed by Natchev. The effectiveness of Natchev's auto-traction (NAT) was evaluated in an open prospective trial on 77 patient with chronic lumbago-sciatica refractory to previous therapies, and herniation of one or more lumbar discs verified by computed tomography (CT) or myelography. Thirty-six of the 77 patients (47%) responded to the treatment in three to ten (median = 5) half-hour sessions. Pain intensity dropped to 27% (median) of the pretreatment intensity. Six months after treatment, 28 of the 36 responders were stable; only four had undergone surgery. By contrast, 20 of the 41 nonresponders had been operated on. The severity of either the radiologic or the neurologic picture was not predictive of the outcome. NAT was as effective as LAT: thus, due to its greater convenience it appears to be suitable as a routine approach in lumbar disc herniation and as a screening technique before surgery.

Adult↗

PubMed1989

In situ arthrodesis without decompression for Grade-III or IV isthmic spondylolisthesis in adults who have severe sciatica.

Eight adults who had back pain and sciatica that was caused by Grade-III or IV isthmic spondylolisthesis of the fifth lumbar vertebra on the sacrum were treated consecutively by in situ arthrodesis without decompression. The anterior displacement of the fifth lumbar vertebra averaged 82 per cent (range, 66 to 118 per cent). The length of follow-up averaged 5.5 years (range, two to fourteen years). All of the arthrodeses resulted in a solid fusion and excellent relief of both the back pain and the sciatica. All of the preoperative neurological deficits resolved, with the exception of a decreased or absent Achilles-tendon reflex in two patients. There were no complications, and all of the patients returned to their preoperative occupations.

Adult↗

PubMed1986

[The best neuroradiological test in the preoperative investigation of lumbar sciatica. The neurosurgeon's point of view].

A short review of the theoretical and practical performance of myelography and computed tomography in the investigation of sciatica is presented. It is concluded that at the present time, myelography remains the primary procedure except in cases of typical, acute sciatica with involvement of a single root where computed tomography can be preferred under certain conditions.

Back Pain↗

PubMed1988

[Treatment of lumbar sciatica with or without neurological deficit using mechanical traction. A double-blind study].

Traction therapy for low back pain with sciatica has been evaluated in a double blind study. 60 patients hospitalized for sciatica with or without signs of sensory or motor deficiency were randomized to 3 treatment groups: "placebo traction" (5 kg), "light traction" (15 kg) and "normal traction" (50 kg). Clinical evaluation after 4, 8 and 12 traction sessions showed no difference between the three groups.

Adult↗

PubMed1985

[Fasting and postprandial blood glucose in subjects with crural pain and sciatica].

The search for diabetes in a patient with crural neuralgia is well established practice. The prevalence of diabetes in the general population is not known, and studies attempting to demonstrate a relationship between diabetes and radiculopathies have been inconclusive. In the present study, fasting and postprandial blood glucose determinations, as well as 14 other parameters, were analyzed in 88 patients with classical sciatica, 27 with crural neuralgia, and 42 with only back pain. Multidimensional statistical analysis revealed that patients with crural neuralgia were older than those with classical sciatica or only back pain, and that there were no differences in blood glucose regulation. The concept that diabetes is found more frequently in patients with crural neuralgia should be revised, since age appears to be the only factor responsible for changes in glucose regulation.

Adult↗

PubMed1985

[Chemonucleolysis in the treatment of surgical sciatica].

Enzymatic dissolution of nucleus pulposus by percutaneous injection of a papain preparation is now used frequently to treat lumbosacral disc hernias responsible for resistant sciatica. Mechanisms of action and techniques are reviewed, and the importance of applying strict criteria for indications for use emphasized. The method should be reserved for nerve root sciatica resistant to medical treatment or physiotherapy, and it constitutes the last stage of conservative treatment. Exclusion criteria are mainly "excluded" disc lesions, major dysfunction or associated spinal vertebral canal stenosis. The optimal indication is represented by the subacute disc hernia in the young. This alternative to open surgery in no way compromises the results in case of failure. Results obtained in a personal series of 150 cases are analyzed comparatively with those reported in the literature.

Adolescent↗

PubMed1985

Intraspinal synovial cyst causing sciatica.

Four patients who had low-back pain and sciatica were diagnosed as having a lumbar intraspinal extradural synovial cyst adjacent to a facet joint between the fourth and fifth lumbar vertebrae. The patients ranged in age from forty-nine to seventy-one years, and the symptoms and signs involved the fourth or fifth lumbar-nerve roots. Roentgenographically, degeneration of the intervertebral discs and facet joints was noted in every patient. Degenerative spondylolisthesis was also a frequent finding. Myelography and computed tomographic scans aided in diagnosis, revealing a soft-tissue lesion, occasionally rimmed with calcification, adjacent to the involved facet joint. The treatment was surgical excision of the cyst, as well as complete laminectomy if there was concomitant spinal stenosis. Follow-up, ranging from eighteen to twenty-five months, revealed complete resolution of the sciatica in all patients.

Aged↗

PubMed1985

The diagnostic accuracy of spinal nerve injection studies. Their role in the evaluation of recurrent sciatica.

The spinal nerve injection study (SNIS) is a diagnostic test for the evaluation of sciatica. SNIS consists of selective infiltration of nerve root with local Xylocaine anesthesia. The most common indication is in the postlaminectomy patient with persistent or recurrent sciatica and peridural scarring causing myelograms or CT scans to be difficult to interpret. Of 105 patients with SNIS, 55 subsequently had surgical exploration of the suspected lesion. In patients with a diagnostic or highly suggestive SNIS, an accurate diagnosis was made in 43 (93%); myelograms in the same group had an accuracy of 24%. At follow-up evaluations ranging from 12 to 60 months (average, 20 months), 40 (73%) of the patients were improved by further surgical treatment.

Adult↗

PubMed1977

[Sciatica caused by massive herniated disk].

On the basis of the surgical findings in 10 cases a description is given of a massive form of disc hernia corresponding to posterolateral displacement of the entire disc with the fibrous ring and cartilaginous surfaces. Such hernias were found in 7 cases of severe lumbar sciatica, including 3 with the cauda equina hemisyndrome and in 3 cases of simple lumbar sciatica operated on for their severe and refractory nature. It is useful to know this variety of hernia so that its uncommon aspect is not surprising on surgery. The term of massive hernia is proposed exclusively for these forms.

Adult↗

PubMed1982

[Treatment of disk sciatica by chemonucleolysis. 120 cases].

One hundred and twenty patients suffering some sciatica due to disc herniation have been treated by chemonucleolysis. All the patients had received conservative treatment for at least four months. The minimum followup after nucleolysis was six months. In 114 patients, radiculography was positive and in 6, radiculography was negative but phlebography was positive. Patients with symptoms of spinal stenosis, or with signs of sequestrated disc or who had been previously operated on by laminectomy were excluded from the study. By a lateral extradural approach, 4000 units of chymopapain were injected into the disc under general anaesthesia after discography. All patients except 3 had only disc injected. Results were good in 92 patients. 21 of the 28 failures were operated on. In 18 cases, a mechanical cause was found at operation with 16 good results. Complications were rare and benign. No neurological complication was noted. It is concluded that chemonucleolysis should be the last step in the conservative management of sciatica.

Acute Disease↗