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A 68-year-old hypertensive male suffering from acute sciatica with pronounced motor disturbances and urinary retention, was found to be suffering from aneurysm of the hypogastric artery. Surgical treatment of the aneurysm resulted in an incomplete recovery. The possible relationships of the aneurysm to the symptoms and treatment are discussed.
The injection of the sacrolumbar roots allows, in the first place, the root to be made opaque in order to determine its morphology and, in the second place and above all, causes the disappearance of the radicular pain after injection of a local anesthetic, which helps the degree of sciatica to be identified. This method, which should be limited to exceptional cases, seems to be useful in patients who have undergone lumbar surgery and for whom the interpretation of contrast x-ray exams poses a particularly delicate problem. It can also be advisable when these exams are not conclusive or when the results do not coincide with the clinical data. Since March, 1974, 18 patients have undergone this exam. In 14 cases the disappearance of the radicular syndrome, after injection of xylocain close to the root, has allowed the root in question to be identified. In 3 cases radicular injection has practically made it possible to rule out an organic lesion. This exam had no side effect and was always tolerated even by two patients allergic to iodine.
A 27-year-old woman with right-sided cyclic sciatica and stiffness of the right hip joint, unresponsive to orthopaedic measures, is presented. An exploratory laparotomy revealed pelvic endometriosis. On oestrogen suppression therapy, she has been symptom-free for eleven months.
334 Types of follow-up data were collected in 158 patients with sciatica. The following information was obtained: (a) in L4-L5 herniations, Achilles tendon reflex disturbance was not explained by S1 root compression, as visualized at this level on myelography, (b) a water-soluble myelogram was also reliable for extreme lateral herniations and only those herniations dislocated into the intervertebral root canal remained undiagnosed, (c) a positive neurological or myelographic diagnosis of herniation did not mean a better short-term prognosis. Operative removal of a large herniated mass gave the best chance of good recovery. The main indication for myelography is a guide to the surgeon for the correct operative level.
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A review of pain clinic patients was carried out to determine whether patients who obtained limited or no relief from epidural injection of steroids derived benefit from subsequent subarachnoid steroid injections. Only 1 of 13 patients who had no benefit from epidural steroids improved following subarachnoid injection. Five of 6 patients with partial relief from epidural steroids had further improvement after subarachnoid injection.
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A technique for radiofrequency localization and coagulation of articular nerves supplying the spinal facets is described and results are reported from a series of 207 patients followed 6 to 21 months (mean 31 months). Relief of pain was achieved in 79% of previously unoperated patients, in 41% of those with laminectomy but no fusion, and in 27% of those with an earlier fusion. No neurological complications were encountered.
Present diagnostic criteria for ankylosing spondylitis (AS) lean heavily on the x-ray examination, but there is much dispute as to its efficacy, especially in mild or early cases. Determinations of the HLA B27 histocompatibility antigen appear to define the population at risk far better than any other means. Of 31 patients who had the HLA B27 antigen, all had negative latex fixation tests and axial polyarthritic complaints (seronegative spondyloarthropathy or rheumatoid variant). Three had Reiter's syndrome and one had ulcerative colitis. Of the remaining 27 patients, nine had definite AS, 11 had probable AS, and seven had possible AS. Eleven of the 27 underwent at least one invasive spinal procedure (myelogram, laminectomy, fusion, facet denervation) before a diagnosis of AS was made.
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