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PubMedDate not supplied

Extra-foraminal prolapsed lumbar disc: a possible cause of recurrent sciatica in failed low-back surgery patient. Case report.

The present report describes the case of a 48 year-old woman who had undergone two separate lumbar laminectomies for a L4-L5 disc. She was admitted for a recurrent sciatica of 6-months duration, which failed to respond to conservative treatment. Myelogram on admission was negative. However CT showed a far laterally placed bulging L4-L5 disc. The patient was successfully reoperated on using a paramedian posterolateral approach on the side of the lesion. The rationale for this approach is discussed.

Cicatrix↗

PubMed1992

[Unsatisfactory results of intradiscal injection of triamcinolone hexacetonide in the treatment of sciatica caused by intervertebral disk herniation].

Sciatica caused by intervertebral disc herniation can be treated with intradiscal injection of chymopapain. A search for a cheaper and less allergizing product led to triamcinolone hexacetonide, this procedure being known as "nucleorthesis". The first results at 6 months were encouraging. In 3 centres where triamcinolone hexacetonide was tested with a more than 2 years' follow-up 92 patients could be evaluated. The results obtained were considered satisfactory in 34 patients (36.9 percent), but they were poor in 19 patients (20.6 percent), and 39 patients (42 percent) had to be operated upon within 2 years. Return to surgery took place within the 6 months following nucleorthesis in 18 patients (19.56 percent) and beyond this period in 17 patients (22.8 percent) with degradation of the results. Moreover, calcifications were found in 19 out of 38 patients; they were of varying size, sometimes detected only at computerized tomography, and some of them appeared to produce symptoms. All considered, the failure rates, the number of patients who required surgery and the occurrence of large and sometimes symptomatic calcifications make triamcinolone nucleorthesis unacceptable compared with the recognized percentages of success with papain nucleolysis and surgical operations. For these reasons, we consider that this treatment should be abandoned.

Anti-Inflammatory Agents↗

PubMed2004

Piriformis pyomyositis: a rare cause of sciatica.

A 30-year-old Thai woman with piriformis pyomyositis presented with sciatica. Computed tomography showed swelling and enhancement of the right gluteus medius and piriformis muscles. She made a complete recovery after a course of intravenous antibiotics. This condition has only been reported three other times and is often diagnosed with difficulty. It could be erroneously dismissed as a lumbar disc prolapse. If untreated, it could lead to prolonged hospital stay and death. A high index of suspicion, early diagnosis and appropriate antibiotic or surgical treatment leads to full recovery.

Abscess↗

PubMed1992

[Non surgical treatment of disk-related sciatica].

The treatment of sciatica due to lumbar disc herniation must be conservative, except if there is severe paralysis or a cauda equina syndrome. First of all, treatment needs bed rest during 15 days, non steroid antiinflammatory drugs and analgesics. In case of failure we propose 2 to 3 epidural injections of corticosteroids. Lumbar brace is often necessary. After 6 weeks of treatment including complete bed rest, radical treatment is proposed, either surgical or percutaneous. If the disc herniation is sequestered or if there is lumbar stenosis, surgery is indicated. In the other cases the choice between chemonucleolysis with chymopapain or percutaneous nucleotomy must be made with the patient informed of the results and complications of the different techniques and according to the results of CT scan or magnetic resonance imaging. Surgery remains efficacious after failure of percutaneous treatment.

Back Pain↗

PubMed1992

[Imaging in sciatica].

Sciatica being a benign disease its outcome is usually favourable, and paraclinical examinations should hold a modest role in its exploration, notably in the first painful episode. In reality, for multiple social, occupational and economic reasons imaging often intervenes at a very early stage of the condition. The role of standard radiography is to exclude non-discal diseases, and it should not need to be repeated in young adults. Computed tomography should be used only after a well-conducted treatment of six to eight weeks duration to demonstrate the responsible discal herniation and its morphological features in order to guide the therapeutic approach. Radiculography should no longer be performed as a first-line examination, but in about one out of ten cases it may be interesting to confirm an uncertain nerve root compression and, above all, to visualize in a standing up patient a container-contained maladjustment such as, for example, a vertebral canal stenosis. Magnetic resonance imaging, a rational, accurate and non-invasive method, unfortunately cannot be used as first-line examination due to its reduced accessibility in France.

Adult↗

PubMed1992

Carbamazepine and sciatica.

Carbamazepine is useful in the management of various painful conditions. The mechanism of its action is not known. Whatever its mechanism, Carbamazepine appears to have a good chance of relieving painful disorders with episodic, flashing pain. Two cases of sciatica responding favourably to carbamazepine are presented in detail.

Carbamazepine↗

PubMed1991

The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia.

In an effort to define the origin of low back pain and sciatica, 193 patients were carefully studied using progressive local anesthesia. These patients had surgery for herniated discs, spinal stenoses, or both. Various tissues were stimulated during the performance of these lumbar spinal operations. This article discusses our observations and the results of that study.

Anesthesia, Local↗

PubMed1991

Social factors and outcome in a five-year follow-up study of 276 patients with sciatica.

Social factors of 179 operated and 97 non-operated patients one year after hospitalization due to low back pain and sciatica were tested by multi-variate regression analysis in relation to the five-year outcome evaluated according to the WHO Handicap Classification. For operated men a subjective working incapacity (relative risk RR = 4.6) and co-morbidity (RR = 2.7) predicted a poor outcome. For operated women the predictive factors were subjective working incapacity (RR = 3.2) and older age (RR = 1.9). For non-operated men an increased occurrence of occupational hazards (RR = 3.6) and for non-operated women co-morbidity (RR = 7.1) indicated a poor outcome.

Adult↗

PubMed1991

Sciatica management: chemonucleolysis vs. surgical discectomy.

True sciatica, and the back pain associated with it, are symptoms stemming from a common anatomical lumbar distortion--compression of a spinal nerve root. Two therapeutic approaches have evolved: surgical laminectomy and discectomy for relief of compression of a lumbar nerve root; and chemonucleolysis, a tissue modification technique using the intradiscal injection of the proteolytic enzyme chymopapain. Chemonucleolysis has been demonstrated to have a successful outcome at the 75% level in 6 weeks and at the 80% level in 6 months. Lumbar microdiscectomy appears to be 85% effective at 3 months.

Humans↗

PubMed1991

Pathophysiology of sciatica.

The exact pathophysiologic mechanisms behind sciatica are incompletely known; however, compression of spinal nerve roots is known to be correlated to both pain and neural dysfunction in a segmental distribution of that specific nerve root. Compression per se may impair the transport of nutrients to the nerve tissue in such a way that affects the nerve root function. There also might be a local affect on nerve roots or root sleeves by substances leaking from the degenerated intervertebral discs.

Animals↗

PubMed1990

Treatment of sciatica. A comparative survey of complications of surgical treatment and nucleolysis with chymopapain.

Chymopapain in the treatment of sciatica by chemonucleolysis has become widespread in the United States and Europe since the approval of this drug for general use by the Food and Drug Administration. Potentially, the increased use of this drug by surgeons with relatively little experience could be expected to cause an increase in the complication rate. This report analyzes the results of a questionnaire sent to surgeons in 316 departments who have recently treated a total of 43,662 patients with this technique. The complication rate was 3.7% (1606 incidents). Of these, 192 (0.45%) were severe. The study revealed that the frequency of severe allergic reactions is lower in Europe than in the United States. Twice the number of anaphylactic reactions occurred with local and neuroleptic anesthesia compared to local or general anesthesia alone. The risk of infectious discitis is low, but a strict sterile technique is mandatory. Neurologic complications were rare, but included 15 cauda equina, one meningeal hemorrhage, a case of epilepsy, and two cases of paraplegia. The rate of complications in this study is comparable to two previous studies; thus, the expected increase in complications has not occurred. For comparison, a survey of 2051 patients treated surgically showed a complication rate of 26% (534 incidents), including 86 (4.2%) severe complications. Among the surgically treated patients, there was a perioperative complication rate of 9.75% (200 incidents) and a postoperative complication rate of 14% (290 incidents), resulting in three deaths. Thus, the surgical treatment was responsible for six times the number of incidents and ten times more severe incidents than for patients treated by nucleolysis.

Adolescent↗

PubMed1990

[Atypical sciatica].

A 46-year old patient had suffered from progressive nocturnal sciatica and motor weakness of the left lower extremity for three years. The physical examination revealed a discrete neurologic deficit of the left L5 and S1 root. By CT a small presacral mass between the L5 and S1 roots was found. During the CT-guided fine needle puncture the patient felt an electrifying pain radiating into the left lower extremity. The cytomorphological examination showed benign mesenchymal cells, indicative of a neurinoma. Since progredient neurological deficit is to be expected, exstirpation of the compressing tumor is the therapy of choice. Our patient however decided to postpone the operation because of only mild symptoms.

Diagnosis, Differential↗

PubMed1990

[The piriformis syndrome--a possible cause of sciatica].

In a 50-year-old patient with unilateral pain in the buttocks and in the sciatica, a radicular compression syndrome was diagnosed. Because conservative therapy failed, surgical intervention for herniated disc was suggested. Clinical examination revealed a painfully contracted piriform muscle and irritation of the sciatic nerve. Through specific stretch exercises, quick recovery was effected. Based on this case report, typical clinical diagnoses and therapeutical possibilities for the piriformis syndrome are discussed.

Contracture↗

PubMed1989

Lateral decompression of a pathological disc in the treatment of lumbar pain and sciatica.

The posterolateral approach external to the vertebral canal allows decompression and the escape of disintegrating bits of abnormal nucleus pulposus. This simple, rapid, and least traumatic procedure is sufficient to relieve and to cure a significant number of patients (approximately 40%) suffering from intervertebral disc-related lumbar pain or sciatica. Among 225 patients with 338 discs operated on by the lateral decompression technique in the interval from 1978 to 1984, the overall results are encouraging.

Adult↗

PubMed1989

[Anomalies of the lumbosacral nerve roots with low backache and sciatica].

Nine patients with lumbosacral nerve root anomalies (NRA) were reported. 36 cases were collected from reported papers in addition, seven types of NRA were classified by the author. They were: conjoined root (with the incidence of 31.11%), near roots (26.66%), two roots in same foreman (20%), anastomosis between roots (11.11%), double roots (4.44%), branch root and combined type (6.66%). The rate of finding of NRA by operation was 0.34%, that was far lower than by myelography and autopsy. Careful exploration can increase the finding rate. NRA can induce backache and sciatica by itself. Its clinical distinguishing features were severe symptoms, compression of multiple nerve roots slight or negative Lasegue sign. The principle of treatment of NRA was adequate decompression, but should be careful to avoid injury of displaced and tensile nerve roots. In this paper, the matters needing attention in operation was discussed as well.

Adult↗

PubMedDate not supplied

[Clinico-radiological analysis of surgically treated sciatica cases].

An analysis included 187 patients treated surgically for sciatica due to vertebral disk pathologies. Nerve roots compression was noted in all examined patients, including 54% of left-sided compression, 43% of right-sided, and 3% of bilateral compression. Majority of cases involved nerve roots in L5 (51%) and L4 (36%) segments of the spine. Intra-operationally 139 (87%) out of 160 abnormal radiculographies have been confirmed. Disk disease was diagnosed in 11 patients despite the lack of changes in radiculography. It may be explained by the extremely lateral prolapse of the vertebral disk. Long term course of the disease and clinical picture decide on surgery in such cases.

Adolescent↗

PubMed1989

[Sciatica caused by a posterior articular cyst. Apropos of 8 cases].

The authors report 8 cases of sciatica secondary to a posterior articular cyst. They emphasize the clinical manifestations permitting to suspect this etiology of root compression, which, until now, was rather unusual. Computerized axial tomography makes the diagnosis possible along with posterior arthrography. This arthrography represents the first stage of the medical treatment by posterior joint infiltration of a steroid derivative. In 60 p. cent of the cases, a definite and persisting improvement permits to avoid a surgical procedure.

Aged↗

PubMed1989

[A case of sciatica with hypertrophy of the calf].

Hypertrophy of the calf associated with sciatica is rare. In the present case there was hypertrophy, predominantly of type I fibers, which showed a high percentage to the detriment of type II fibers. In the previously reported cases, the type of hypertrophied fibers was variable and pseudomyotonic discharges were inconstantly recorded. The mechanism underlying the hypertrophy is unknown. Inequality of size of muscle fibers could result from proximity of atrophic fibers and those with compensatory hypertrophy. The increased proportion of type I fibers could be the consequence of compensatory hypertrophy induced by lesions of synergic muscles and/or muscle compartments.

Female↗