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At least 397 records · Page 22Linked to original sources

PubMed1981

The cold foot symptom in sciatica. A clinical and thermographic study.

A thermographic study on admission of 174 hospital patients with sciatica revealed a significant correlation between decreased temperature of the distal part of the affected limb and the probability of spinal nerve root compression. The highest order of preponderance for "coldness" was related to the group of patients whose symptoms were confirmed surgically as those of a herniated disc. The follow-up thermograms of 30 patients, on the average 29,4 months postoperatively showed correlation between normalization of the temperature and the relief of symptoms. Opinions regarding the neurophysiological mechanism of peripheral vasomotor control are controversial and the findings give rise to discussion of its complex pattern. Hypothetically derangement of anterograde axoplasmic transport of vasodilatory peptide macromolecules to the skin vessels may be involved.

Adolescent↗

PubMedDate not supplied

Intraoperative straight-leg raising during laminectomy and disk excision for sciatica.

During lumbar disk excision for sciatica, doubts may occasionally arise as to the level of the lesion or the degree of involvement of the particular nerve root being observed. Following removal of the obstructing agent, can we be certain that liberation of the nerve root is complete? These anxieties can be dispelled by performing a straight-leg raising test bilaterally during the operation both before and after removal of the obstructing agent. The intraoperative straight-leg raising tests enable observations to be made as to the degree of nerve tension on the involved side as compared with tension on the uninvolved side; at the end of the operation, the tension on the involved side should be no more than the tension on the uninvolved side. When the straight-leg raising test is not being performed, it should be possible for the nerve root to be displaced to the midline of the spinal canal with ease.

Humans↗

PubMed1995

Preliminary experience with percutaneous laser disc decompression in the treatment of sciatica.

OBJECTIVE: To examine the usefulness of percutaneous laser decompression of a herniated lumbar intervertebral disc. DESIGN: A case series. SETTING: A university-affiliated hospital. PATIENTS: Sixteen patients with clinical and radiologic evidence of herniated lumbar intervertebral discs. INTERVENTIONS: Percutaneous introduction of a fine optical fibre into a herniated lumbar disc and delivery of short pulses of laser energy. MAIN OUTCOME MEASURE: The relief of intractable leg pain. RESULTS: Nine of 14 patients with intractable leg pain experienced total relief after percutaneous laser disc decompression. Four patients required subsequent microsurgical discectomy, and one required a decompressive laminectomy. Of the two patients who had back pain as their major complaint, one required microsurgical discectomy after laser disc decompression. CONCLUSIONS: Percutaneous laser disc decompression can relieve sciatica caused by a herniated intervertebral disc. The technique requires limited use of health resources. Preliminary results suggest that an early return to work can be expected in patients successfully relieved of their leg pain.

Adult↗

PubMed1995

Diagnosis and management of low back pain and sciatica.

Acute low back pain with associated sciatica is usually a benign, self-limited disorder. Appropriate medical treatment may include passive forms of physical therapy, including McKenzie exercises, manipulation, medication and therapeutic injections. After pain is controlled, the patient should be taught self-management techniques, including exercises and ergonomic protection of the spine. Evidence is increasing that exercise programs are effective, although the optimal regimen has yet to be defined and may vary from patient to patient. Chronic low back pain is a complex disorder that must be managed aggressively with a multidisciplinary approach that addresses physical, psychologic and socioeconomic aspects of the illness. Self-administered traction, corsets, medications and other treatment methods may prove to be useful adjuncts to an active program of exercise and education that promotes functional restoration.

Algorithms↗

PubMed1994

Hamstring tightness and sciatica in young patients with disc herniation.

We evaluated the nerve roots of the cauda equina by CT myelography in 36 patients aged from 11 to 19 years with lumbar disc herniation. On straight-leg-raising tests, six younger patients had isolated hamstring tightness with no sciatica (group A) and 30 had sciatic pain (group B). CT myelography showed that no patient in group A had associated nerve-root swelling, and that the roots were displaced posteriorly, but not compressed. In 21 of the group-B patients, swelling of the nerve roots was confirmed, with compression between the herniated disc and the superior articular process. Our findings suggest that hamstring tightness in these patients may be caused by a different mechanism from that which causes sciatic pain.

Adolescent↗

PubMed1994

[Sciatica and herniated disk. Current aspects of pathophysiology and pain mechanisms].

Pathoanatomical and pathophysiological aspects of spinal nerve roots involved in disk herniation are discussed, and recent advances in our understanding of nerve root physiology and pathophysiology summarised. Evidence is presented suggesting that nerve roots may be affected not only by mechanical compression but also by nucleus pulposus tissue via biochemical mechanisms. Clinical symptoms are also discussed, as are recent findings regarding the diagnosis and treatment of disk herniation and sciatica.

Ganglia, Spinal↗

PubMed1994

Back pain, sciatica and disability following first-time conventional haemilaminectomy for lumbar disc herniation. Use of "Low Back Pain Rating Scale" as a postal questionnaire.

To determine the value of "Low Back Pain Rating Scale" as a postal questionnaire, a retrospective study was undertaken of patients who had undergone first-time lumbar disc surgery 14-72 months previously. Rate of response was 86% (261/304). From the results, it was concluded that 87% of the patients felt that a satisfactory surgical outcome was obtained; 67% had minor or major functional restrictions of their daily activities; 65% experienced significant low-back symptoms in the period prior to follow-up examination; and 57% experienced sciatica. Thirty-seven patients were receiving pensions in the postoperative period due to continued back pain. "Low Back Pain Rating Scale" used as a postal questionnaire was found to be useful in determining general overall assessment status in patients who had undergone lumbar surgery. This evaluation method could be used as a quality control in future studies regarding this patient group.

Adult↗

PubMed1993

The natural course of acute sciatica with nerve root symptoms in a double-blind placebo-controlled trial evaluating the effect of piroxicam.

To study the natural history of acute sciatica, 208 patients with obvious symptoms and signs of a lumbar radiculopathy (L5 and S1) were examined within 14 days of onset. A concomitant double-blind investigation of the effect of the nonsteroidal anti-inflammatory drug piroxicam was performed. The results measured by visual analog scale and Roland's functional tests showed a satisfactory improvement throughout the 4 weeks of observation. The piroxicam-treated group had same results as the control group. Based on questionnaires at months 3 and 12 approximately 30% of the patients still complained about back trouble and 19.5% were out of work after 1 year. Four patients underwent surgery during this period.

Adult↗

PubMedDate not supplied

Sciatica as the first manifestation of synovial sarcoma. Contribution of magnetic resonance imaging to the diagnosis.

A 38-year-old man presented with paralyzing sciatica as the first manifestation of synovial sarcoma of his right leg. Although neurologic symptoms sometimes occur as manifestations of synovial sarcoma, they are exceptionally inaugural. Magnetic resonance imaging is a valuable tool in patients with synovial tumors, both for establishing the diagnosis and for evaluating the extent of the lesion.

Adult↗

PubMed1996

Spondylolisthesis with sciatica. Magnetic resonance findings and chemonucleolysis.

Fifteen patients with bilateral lumbar isthmic spondylolisthesis and unilateral sciatica were examined with magnetic resonance imaging. All patients had a disc protrusion at the level of the spondylolisthesis. Nine patients had a central herniated disc that caused dural sac deformation; in 6 of these patients there was extension to the disc tissue into the foramen. In 5 patients there was no clear dural sac deformation, but there was a foraminal disc protrusion that caused nerve root compression. In 1 patient there was a hernia lateral to the foramen. In none of the patients was there evidence of compression by bony elements. No abnormalities on adjacent levels were found. All 15 patients were treated with chemonucleolysis. There were no complications. A followup study was done after 19 months (range, 10-42 months). The result was rated as good or excellent in 10 of 12 patients with a spondylolisthesis of L5 and in 1 of 3 patients with a spondylolisthesis of L4. Magnetic resonance imaging showed a decrease in dural sac deformation in 4 patients, no clear decrease in 3, and a slight increase in 2. There were no distinct foraminal changes in 9 of 11 patients.

Adult↗

PubMed1996

Alternating sciatica while jogging: an early symptom of cauda equina tumor.

Three athletic patients with cauda equina or lumbosacral cord tumor noticed, as an early symptom of the disease, alternating bilateral sciatica synchronized with each stride while jogging. Comparison with athletic patients who developed lumbar disc hernia suggested that this symptom was significant. The authors speculated that the mechanism producing this symptom is the inertial force induced while jogging, which acts on the tumor in its early stage, when it is still quite mobile in the intradural space. The diagnostic role of this symptom in cauda equina and lumbosacral cord tumor should be recognized.

Adolescent↗

PubMed1997

Sciatica as the first manifestation of a leiomyosarcoma of the buttock.

We report the case of a 22-year-old woman who was admitted for inflammatory right-sided sciatica with a decline in general health. Laboratory tests showed severe inflammation. Ultrasonography and computed tomography of the buttock and pelvis demonstrated a large tumor in the deep muscles of the right buttock, with an intrapelvic component that displaced the pelvic organs without invading them. Histologic examination of a biopsy specimen taken via the buttock established the diagnosis of leiomyosarcoma. Surgery by a pelvic approach allowed partial resection of the tumor, which was seen to invade the sciatic nerve. Radiation therapy was given. Six months later the residual tumor was considerably larger and the patient's general health had deteriorated further. Leiomyosarcomas are rare tumors whose diagnosis rests on histologic examination of biopsy or surgical specimens. The treatment is surgical. Recurrences are seen in 40 to 60% of cases, and metastases in 27 to 60%. The place of radiation therapy and chemotherapy in the treatment of leiomyosarcoma remains unclear.

Adult↗

PubMed1998

[L5 sciatica caused by the compression of the lumbo-sacral trunk of osseous origin at the sacro-iliac level. Treatment by an antero-lateral subperitoneal approach].

A 42 years old patient presented with a 4 years history of a left L5 sciatica unresponsive to a previous L4-L5 surgical decompression. CT scan showed a solid tumor developed on the anterior aspect of the sacro-iliac joint, in contact with the lumbo-sacral trunk. An antero-lateral extraperitoneal approach was performed, with progressive subperitoneal dissection along the inner aspect of the iliac wing to the sacro-iliac joint and sacral ala. The exostosis was removed with "en block" excision, Postoperatively pain completely disappeared. Considerations are made on the mechanism of the compression as well as on the surgical approach performed.

Adult↗

PubMed1976

Cyclic sciatica of endometriosis. Case report.

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.

Adult↗

PubMed1984

A comparison of surgery and chemonucleolysis in the treatment of sciatica. A prospective randomized trial.

Fifty-two patients with unilateral sciatica caused by intervertebral disc herniation were selected on strict clinical and radiological criteria. All patients had failed to respond to conservative measures. Patients in this trial group randomly were allocated surgery or Chymopapain. During the same period, a further 71 patients, who were put forward for the trial, and did not fulfill the trial criteria, were offered Chymopapain as an alternative to surgery. Both groups were assessed at one month, three months, and one year--progress being recorded by clinical examination and visual analogs. The failure rate in the two Chymopapain groups were comparable, with 52% and 47%, but were significantly higher than the surgical group (11%). Surgery in the failed Chymopapain group frequently was delayed and unrewarding. Failures can be predicted at one month posttreatment, and early surgery may be indicated to prevent chronic scarring.

Adolescent↗

PubMed2000

The Cochrane review of bed rest for acute low back pain and sciatica.

STUDY DESIGN: A systematic review within the Cochrane Collaboration Back Review Group. OBJECTIVES: To assess the effects of advice to rest in bed for patients with acute low back pain (LBP) or sciatica. SUMMARY OF BACKGROUND DATA: Low back pain is a common reason for consulting a health care provider, and advice on daily activities constitutes an important part in the primary care management of low back pain. METHODS: All randomized studies available in systematic searches (electronic databases, contact with authors, and reference lists) were included. Two reviewers independently selected trials for inclusion, assessed the validity of included trials, and extracted data. Investigators were contacted to obtain missing information. RESULTS: Nine trials with a total of 1435 patients were included. Four trials compared bed rest with advice to stay active, and the overall results were heterogeneous. Overall, results from two high-quality studies indicate no difference in pain intensity at the 3-week follow-up (standardized mean difference 0.0; 95% confidence interval [CI] -0.3, 0.2]), and a small difference in functional status in favor of staying active (weighted mean difference 3.2 [on a 0-100 scale] 95% CI 0.6, 5.8). In two high-quality trials no differences were reported in pain intensity between 2-3 days of bed rest and 7 days of bed rest. In another two high-quality trials, no differences were found between bed rest and exercises in pain intensity or functional status. CONCLUSION: Bed rest compared with advice to stay active at best has no effect, and at worst may have slightly harmful effects on LBP. There is not an important difference in the effects of bed rest compared with exercises in the treatment of acute low back pain, or 7 days compared with 2-3 days of bed rest in patients with low back pain of different durations with and without radiating pain.

Activities of Daily Living↗

PubMed2003

Can the sacroiliac joint cause sciatica?

In this brief study we provide evidence that earlier and more recent findings pertaining to the anatomy and physiology of the sacroiliac joint suggest that dysfunction in this joint could, similar to a herniated lumbar disc, produce pain along the sciatic nerve. These observations might explain some of the cases of sciatica in which no disc pathology can be found.

Journal Article↗

PubMed1977

Short term prognosis in sciatica. A prospective study of factors influencing the results with special reference to myelography.

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.

Adolescent↗