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At least 271 records · Page 15Linked to original sources
PubMed1987

Epidural application of cortico-steroids in low-back pain and sciatica.

Seven women and nine men, aged 27-59 years (mean 45), with lumbar pain and sciatica had epidural blocks once with 80 mg of depo-medrol and lidocaine in individual doses. All had static and kinetic lumbar pain up to 16 years and all but four also pain radiating to the lower limbs. Radiculography was "negative" in all patients, but three exhibited minor neurological abnormalities. Five patients had had a lumbar hemilaminectomy previously. In case of segmental pain in the lower limbs the appropriate level was used, in all other patients injection was done in L3-4 interspace. By means of a visual analogous scale 10 patients (62%) stated relief of half the pain the following day. One month later only 7 patients (43%) stated relief of one third of the pain. Only one patient benefited ultimately (after 6 months). In the remainder complaints were unaffected by the epidural injection. These discouraging results are not compatible with other reports, and a planned double-blind randomized investigation was abandoned. For the present category of patients (long-lasting complaints, previous "disc" operations) we found the epidural steroid injection useless.

Adrenal Cortex Hormones↗
PubMed2002

Myelopathy and sciatica induced by an extradural S1 root haemangioblastoma.

Haemangioblastomas are vascular tumours which mainly involve the central nervous system and retina, often in the setting of von Hippel-Lindau disease. Haemangioblastomas occurring outside the central nervous system are uncommon. Wherever it is, recognising this tumour prior to surgery is desirable, as preoperative embolisation may be considered. We report the clinical, imaging and pathological features of a sporadic sacral root haemangioblastoma in a 58-year-old man with chronic sciatica and myelopathy. The diagnosis was questioned preoperatively because an enlarged sacral foramen, seen to be filled by a highly vascular, enhancing mass and dilated vessels. Myelopathy was attributed to the presumed high venous pressure resulting from increased flow in veins draining the vascular tumour. Microneurosurgical excision was performed after endovascular embolisation and led to persistent clinical improvement.

Cerebellar Neoplasms↗
PubMed2004

Cyclic sciatica caused by infiltrative endometriosis: MRI findings.

Endometriosis, an important gynecological disorder of reproductive women, affects most commonly the ovaries and less frequently the gastrointestinal tract, chest, urinary tract, and soft tissues. Endometriosis classically appears on MRI as a mass with a large cystic component and variable signal intensities on T1- and T2-weighted images due to the presence of variable degradation of hemorrhagic products. Endometriosis in an atypical location, an infiltrative appearance and without cystic-hemorrhagic components has rarely been described. We report on a 33-year-old woman with cyclic sciatica due to histologically documented infiltrative endometriosis involving the area of the left sciatic notch.

Adult↗
PubMed2005

Determinants of lumbar artery occlusion among patients with sciatica: a three-year follow-up with magnetic resonance angiography.

We showed previously that chronic Chlamydia pneumoniae infection increases the risk of lumbar artery occlusion. We did not evaluate, however, the effect of other risk factors for cardiovascular diseases in combination with this chronic infection. The purpose of this study was to investigate the combined effect of chronic C. pneumoniae infection and other known determinants of artery occlusion in a population of sciatica patients. Two-dimensional time-of-flight magnetic resonance angiography (MRA) was used to evaluate lumbar arteries at baseline and three years. The arteries on both sides (L1-L4) were evaluated visually and scored as normal, narrowed or occluded. Logistic regression analysis was performed separately for baseline total arterial stenosis and each L1-L4 segmental artery pair, and for incident new stenosis during the follow-up period. The determinants analyzed included age, body mass index (BMI, kg/m(2)), education, gender, and smoking, in addition to presence of chronic C. pneumoniae infection. MRA was obtained at baseline for 147 patients and at 3 years for 134 patients. Sixty-four (47.8%) of 134 patients had new arterial stenosis. Total incidence of new arterial stenosis was distributed quite evenly between the individual segmental levels, varying from 12.7 to 18.6%. BMI was the only predictor of new arterial stenosis (odds ratio (OR) 1.13). A reasonable logistic model could be established only for baseline L4 and total arterial scores. At L4, education was a protective factor (OR 0.07), whereas age (OR for the oldest age group 6.7) and BMI (OR 1.17) were associated with increased risk of occlusion. For total arterial score, chronic C. pneumoniae infection was an independent determinant of arterial occlusion, increasing the risk to almost eightfold. Additionally, BMI (OR 1.16), and age (for the oldest age group OR 11.4) were significant determinants for stenosis. Smoking was not statistically significant. As chronic C. pneumoniae infection was an independent determinant of lumbar artery occlusion, treatments of this chronic infection may have an impact on lumbar diseases. The importance of BMI for new arterial stenosis suggests that weight reduction may also have a beneficial effect in lumbar artery disease.

Adult↗
PubMed2005

Outcome of invasive treatment modalities on back pain and sciatica: an evidence-based review.

Within the framework of evidence-based medicine high-quality randomised trials and systematic reviews are considered a necessary prerequisite for progress in orthopaedics. This paper summarises the currently available evidence on surgical and other invasive procedures for low back pain. Results of systematic reviews conducted within the framework of the Cochrane Back Review Group were used. Data were gathered from the latest Cochrane Database of Systematic Reviews 2005, Issue 2. The Cochrane reviews were updated using the evidence summary on surgery and other invasive procedures from the COST B13 European Guidelines for the Management of Acute and Chronic Non-Specific Low Back Pain. Facet joint, epidural, trigger point and sclerosant injections have not clearly been shown to be effective and can consequently not be recommended. There is no scientific evidence on the effectiveness of spinal stenosis surgery. Surgical discectomy may be considered for selected patients with sciatica due to lumbar disc prolapses that fail to resolve with the conservative management. Cognitive intervention Combined with exercises is recommended for chronic low back pain, and fusion surgery may be considered only in carefully selected patients after active rehabilitation programmes during 2 years time have failed. Demanding surgical fusion techniques are not better than the traditional posterolateral fusion without internal fixation.

Humans↗
PubMed2002

Proinflammatory cytokines in cerebrospinal fluid and serum in patients with disc herniation and sciatica.

Proinflammatory cytokines have been identified in herniated intervertebral discs in humans, and such cytokines have experimentally been demonstrated to be important in the pathophysiological mechanisms of disc herniation. Cerebrospinal fluid (CSF) and serum concentrations of interleukin (IL)-1beta IL-6, IL-8, interferon (IFN)-gamma and tumour necrosis factor (TNF)-alpha were investigated using the enzyme-linked immunosorbent assay (ELISA) technique in 39 patients with lumbar disc herniation and sciatica. Pain duration and pain intensity (visual analogue scale, VAS) were recorded at inclusion, and a clinical examination was performed evaluating neurological findings. The extent of disc herniation (protrusion or extrusion/sequestration) was evaluated perioperatively. Normal concentrations of IL-1beta, IL-6, IFN-gamma and TNF-alpha were present in CSF and serum in almost all patients with lumbar disc herniation. The concentrations of IL-8 in CSF were increased in 12 out of 39 patients, and these increased levels of IL-8 correlated to a short duration of pain and to more pronounced herniation (extrusion or sequestration). No relationship between IL-8 concentrations in CSF and pain intensity, positive neurological findings or a positive straight leg-raising (SLR) test was found. The observation of increased concentrations of IL-8 in CSF in patients with a short duration of symptoms supports the concept of the initial involvement of inflammatory mechanisms after a disc herniation. The finding that most of the patients with increased concentrations of IL-8 in CSF had an extrusion or a sequestration may suggest that the increase in IL-8 is related to mechanical nerve root compression, but may also indicate a biochemical effect exerted by the herniated disc on the surrounding tissue. Further studies on the potential role of IL-8 as a biomarker for disc herniation are warranted.

Adult↗
PubMed2005

Acute thrombosis of inferior vena cava in a pregnant woman presenting with sciatica: a case report.

A 20-year-old pregnant woman was admitted to our department with symptoms of deep venous thrombosis in the left lower extremity and excessive lumbar pain. Low-molecular-weight heparin was administered. She recovered with this treatment, however, severe lumbar pain continued. A lumbar magnetic resonance image showed dilated epidural veins compressing the roots and acute thrombosis of the inferior vena cava extending to renal veins. During the same period she had acute deep venous thrombosis in her right leg. An urgent venous thrombectomy was performed. Sciatica and deep venous thrombosis resolved after the operation. Low-molecular-weight heparin was administered until the end of her pregnancy.

Acute Disease↗
PubMed1995

Congenital pelvic arteriovenous malformation: a rare cause of sciatica.

A patient with a large congenital pelvic arteriovenous malformation presenting with irradiating pain to the leg, most likely due to sciatic nerve compression, is described. Congenital pelvic arteriovenous malformation are rare lesions, especially in males. Diagnosis was established by arteriography and contrast-enhanced computed tomography scan. Surgical resection of the AVM relieved our patient of all symptoms. However, endovascular therapy, either as primary treatment or followed by conventional surgery is the treatment of choice. Pelvic arteriovenous malformations should be considered in the differential diagnosis of unexplained sciatica.

Aortography↗
PubMed1980

A statistical analysis of percutaneous radiofrequency lesions in the treatment of chronic low back pain and sciatica.

A statistical analysis of 61 consecutive patients who underwent facet denervation for chronic low back pain and sciatica showed that the average patient improved with lower pain estimates and use of narcotics, while activity levels increased. At 1-2 year follow-up there was a trend for patients to report an increase in their pain estimate although they maintained consistently high acativity levels and low analgesic intake.

Back Pain↗
PubMedDate not supplied

Transforaminal periradicular infiltration guided by CT for unilateral sciatica--an outcome study.

Selective transforaminal periradicular infiltration with local corticosteroids and anesthetics has been performed for preoperative evaluation of lumbosacral pain and for patients with sciatia. From July 2001 to November 2003, 143 patients with unilateral sciatica were treated with computed tomography (CT)-guided transforaminal periradicular infiltration. Needle puncture was possible without difficulty in all patients. Of all 143 infiltrations, 140 were followed up with the recovery of leg and back pain and improvement of the straight leg-raising test (SLRT). Minor complications were seen, but major complications and mortality did not occur in our series. In summary, CT guidance allows safe and precise needle positioning, and it can readily demonstrate the spread of the medications in the exact periradicular space.

Adult↗
PubMed2004

Herpes zoster sciatica with paresis preceding the skin lesions. Three case-reports.

We report three cases of herpes zoster sciatica with motor loss preceding the typical skin lesions. Serological tests and cerebrospinal fluid examination established the diagnosis. Two patients had residual motor loss after 1 and 3 months, respectively. Immunodepression and other risk factors should be looked for routinely. Early diagnosis and treatment may improve the prognosis. Tests for antibodies or viral DNA in cerebrospinal fluid can be helpful, although negative results do not rule out the diagnosis.

Aged↗
PubMed2006

Prevalence and risk factors of disk-related sciatica in an urban population in Tunisia.

BACKGROUND: Disk-related sciatica (DRS) creates a public health burden because of its high incidence and considerable socioeconomic costs. We are not aware of previous epidemiological studies of the prevalence and risk factors of DRS in Tunisia or other Arab countries, and few studies have addressed these issues elsewhere. OBJECTIVES: To determine the prevalence and incidence of DRS in Monastir, Tunisia; to look for risk factors; and to evaluate socioeconomic costs. METHODS: Data on a cross-section of 5000 individuals aged 15 years or older living in Monastir were collected by interviewers using a previously developed 51-item questionnaire. RESULTS: The study participation rate was 87.6%. The annual prevalence of DRS was 2.21% and the incidence was 1.44%. Among the patients with DRS, 94.8% received healthcare interventions, 64% had plain radiographs taken, and 45.4% underwent computed tomography of the lumbar spine. Sick leaves were given to 77.7% of patients, and mean sick leave duration was 9 weeks. A change in job was required in 5.5% of cases. Factors associated with DRS included male gender (P<0.001), obesity (P<0.0001), smoking (P<0.0001), a history of low back problems (P<0.0001), anxiety and depression (P<0.0001), a job requiring prolonged standing and bending forward (P<0.03), heavy manual labor (P<0.005), heavy lifting (P<0.0001), and exposure to vibrations (P<0.0001). CONCLUSION: The prevalence of DRS in Monastir is 2.2%. We identified a number of patient- and occupation-related risk factors. The high socioeconomic cost should encourage preventive measures.

Adolescent↗
PubMed1987

The investigation of sciatica and low back pain syndromes: current trends.

This report is based on a 3 month study visit to the United States undertaken in the summer of 1985 and sponsored by the Kodak Travel Scholarship. The current attitudes and trends in the investigation of patients with sciatica and low back pain syndromes will be discussed, with a particular emphasis on high resolution computed tomography of the lumbar spine.

Back Pain↗
PubMed2004

Unusual presentation of sciatica in a 14-year-old girl.

The sciatic nerve can be compressed by a variety of causes, while intervertebral disc herniation is the most common cause of sciatica [Surg. Neurol. 46 (1996) 14], other documented causes include, infection, neoplasm, degenerative disease of a spine, congenital anomalies and traumatic posterior hip dislocation [BMJ 287 (1983) 157]. Sciatic neuropathy in children is uncommon. We present an unusual case of sciatic nerve compression in a 14-year-old-girl that was caused by an avulsion fracture of the ischial tuberosity. The compression was relieved by surgical excision of the avulsed ischial tuberosity.

Adolescent↗
PubMed1998

Clinical signs in patients with brachialgia and sciatica: a comparative study.

BACKGROUND: The aim of the study was to compare the clinical signs of patients with cervical and lumbar root affections. METHODS: From January 1994 to January 1995, we performed a prospective study on 395 patients. The study comprised 93 patients with a cervical and 302 patients with a lumbar root affection. 338 patients underwent surgery. General data, case histories, and neurological findings were analyzed. RESULTS: The patients with brachialgia had a nonradicular pain radiation in 67%, the patients with sciatica only in 35%. All other data showed no significant differences. The investigation also shows that a radicular pain radiation is significantly correlated with an unequivocal radicular deficit. In particular, the patients with a cervical radicular pain radiation had a highly significant incidence of a radicular neurological deficit. CONCLUSIONS: We could demonstrate in this prospective study that only about one third of the patients with a cervical root affection showed an unequivocal radicular pain radiation. This contradicts the traditional medical textbook concept of a cervical root compression syndrome. This difference in respect of the clinical signs of lumbar and cervical root compressions might be explained by the anatomical variations of cervical root anastomoses. To determine the affected cervical root level, further investigation of the myotomes is recommended.

Brachial Plexus Neuritis↗
PubMed2003

What do patients think? Results of a mixed methods pilot study assessing sciatica patients' interpretations of satisfaction and improvement.

BACKGROUND: Little is known about the issues low back pain patients take into account when deciding their satisfaction with care, the importance placed on such satisfaction, or the factors they consider when assessing their overall improvement. OBJECTIVE: The purpose of this study was to explore these issues and to assess the feasibility of implementing qualitative research methods within a clinical trial. METHODS: Study participants were volunteers taking part in a randomized clinical pilot study comparing nonsurgical treatments for sciatica. Face-to-face interviews were conducted, transcribed, and analyzed using content analysis. RESULTS: All 31 individuals who participated in the pilot study were interviewed. When asked which issues they considered when deciding their satisfaction with care, the most frequently identified themes were change in pain, personnel, and the treatment experience. When assessing their overall improvement, all participants considered whether their pain had changed. In response to the question asking participants which outcomes they considered to be most important, severity of pain and quality of life were most commonly cited. CONCLUSION: This study demonstrated that a "mixed methods" approach using qualitative research methods within a clinical trial is not only feasible but can provide interesting and useful information for trial interpretation and future study design. By providing insight to the multidimensional nature of patients' beliefs and perceptions, this technique may not only shape but also redefine the focus of patient-oriented research and health care for low back pain conditions.

Adult↗
PubMed1997

[Bilateral sciatica: a predictive sign of extradural hematoma after lumbar disk herniation].

The authors analyse five cases, in order to recognize a sensitive early clinical feature of extradural haematoma following lumbar diskectomy. Neither time delay (time from surgery to the suspicion of the diagnosis) nor pain intensity (a subjective factor which might be obtunded by an analgesic drug) are valuable features. The only reliable predictive sign is bilateral sciatica, which occurred in all cases, before the diagnosis was confirmed by a sensitive and motor deficit in the lower limbs.

Adult↗