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At least 649 records · Page 36Linked to original sources
PubMed2000

Epidural corticosteroid injection in the conservative management of sciatica.

In this prospective randomized clinical trial, the results of epidural corticosteroid injections were evaluated in patients with lumbosciatic pain caused by herniated nucleus pulposus. Thirty-six patients with radicular lumbosciatic pain and positive straight leg raising test because of confirmed prolapsed intervertebral lumbar discs were randomized into two groups with (17 patients) and without (19 patients) epidural corticosteroid injection. Members of the treatment groups received three injections of 100 mg methylprednisolone in 10 mL bupivacaine 0.25% each. Additional therapy was standardized and identical in both groups. Followup examinations were performed at 2 weeks, 6 weeks, and 6 months. The examinations included pain level (visual analogue scale), straight leg raising test, and functional status (Hannover Functional Ability Questionnaire). At 2 weeks, patients receiving methylprednisolone injection showed a significant improvement in straight leg raising test results compared with patients in the control group. Results were better in the methylprednisolone group, although not statistically significant for pain relief and mobility. At 6 weeks and 6 months, pain relief, improvement of straight leg raising, and improvement of functional status showed no statistical significance. Epidural corticosteroid injections can be recommended as additional therapy only in the acute phase of the conservative management of lumbosciatic pain.

Adult↗
PubMed1980

Role of computed tomography in patients with "sciatica".

The computed tomography (CT) findings in 10 patients who presented with lumbosacral radicular symptoms are reported. The CT scans were performed after the more commonly used radiologic studies, including plain films and myelography, had failed to completely define the nature or extent of the underlying disease process. The final diagnoses were metastatic neoplasm to the spine and soft tissue in six cases, primary neoplasm of the sacrum or soft tissue in three cases, and tuberculous osteomyelitis and abscess in one case. The limitations and potential complications of the various radiologic examinations are discussed, and the potential value of CT in selected patients with lumbosacral neuropathy is presented.

Adult↗
PubMed1987

Serial measurements of fibrinolytic activity in acute low back pain and sciatica.

A fibrinolytic defect is common in chronic back pain syndromes. Its role in the chronicity of these conditions is not fully understood. To elucidate the possible mechanisms, 11 patients with acute low back pain were studied over 12 months and compared with controls. The patients showed prolongation of the euglobulin lysis time throughout the study; the fibrin plate lysis area was initially normal but became abnormal within 2 weeks. In five patients, the symptoms resolved and the initial fibrinolytic defect improved. In contrast, the fibrinolytic defect remained in six patients with persistent pain. These results suggest that the fibrinolytic defect is secondary to mechanical damage but, if persistent, may become a secondary pathogenic factor associated with the chronicity of some back pain problems.

Adult↗
PubMed1990

A prospective study of nerve root infiltration in the diagnosis of sciatica. A comparison with radiculography, computed tomography, and operative findings.

Fifty nerve root infiltration studies were evaluated prospectively in a consecutive series of 50 patients referred to the Sheffield Problem Back Clinic with complicated back problems. All were over 35 years of age (mean, 51 years). Ten (20%) demonstrated abnormal segmentation of the lumbar spine. Sixteen (32%) had undergone previous surgery. Before nerve root infiltration all patients were investigated by radiculography and computed tomography. Nerve root infiltration identified two types of response. In 20 patients, infiltration reproduced the symptomatic pain, which then was abolished by local anesthetic--the positive result. These patients were considered suitable for surgery. One patient in this group had spontaneous resolution of pain and thus did not undergo operative treatment. In 30 patients, infiltration did not reproduce the symptomatic pain regardless of the level studied, or only partially reproduced the pain at two or more levels--the negative result. Radiculography and computed tomography in these patients also was inconsistent. This group were considered unsuitable for surgery. In those patients undergoing surgical decompression, nerve root infiltration correctly identified the symptomatic level in 18 of the 19. Computed tomography and radiculography identified the level in 14 and 12 patients, respectively.

Contrast Media↗
PubMed1993

Diabetic lumbar radiculopathy: sciatica without disc herniation.

Three patients with diabetic radiculopathy (DR) are presented. The clinical aspects of DR, its management, and differential diagnosis are reviewed. Diabetic radiculopathy commonly presents with severe unilateral pain of sudden onset that is usually located in the lower extremity, frequently in the proximal segments. Occasionally, bilateral asymmetric pain may be observed. The pain is severe and may require narcotic medications. Sphincteric involvement is rare. Weakness of hip or thigh muscles, decreased sensation and hypo- or areflexia are commonly observed. The clinical picture can resemble that of high lumbar disc herniation. Electrodiagnostic and radiological studies may help differentiate between the two conditions.

Aged↗
PubMed1994

New-onset sciatica after automated percutaneous discectomy.

This is a case report of a 24-year-old patient who underwent percutaneous discectomy at L5-S1 for relief of lower back pain. Postoperatively, new-onset acute right lumbar radicular syndrome developed and the postoperative MRI scan confirmed a far lateral extraforaminal disc herniation at L5-S1 with compression of the right nerve. This corresponded to the nucleotomy site of the probe. This case report emphasizes that all physicians who treat herniated nucleus pulposus should be well versed in all aspects of treatment including complications.

Adult↗
PubMed1994

The effect of neck and leg flexion and their sequence on the lumbar spinal cord. Implications in low back pain and sciatica.

STUDY DESIGN: Fresh cadavers of five baboons were used to assess lumbar spinal cord movement. Window dissection at the L3 level was performed to observe the relative displacement of the cord to bony landmark, when the neck and hip were moved. OBJECTIVES: To examine the effect of the neck and hip flexion alone and in combination on the movements of the lumbar spinal cord relative to the third lumbar vertebral body. To investigate also the effect of the sequence of flexions. SUMMARY OF BACKGROUND DATA: Several clinical studies claim that cervical flexion together with straight leg raise tensions the lumbar nerve root. Although previous studies describe the effect of each of these movements, there have been no measurements of the combined effect or the effect of the sequence of movements. METHODS: Five fresh baboon cadavers were dissected to expose the L3 nerve root. The movement of the lumbar cord at that level was measured relative to a pin on the L3 vertebra. The neck and leg of the cadavers were moved by two operators. RESULTS: Cervical flexion always moved the lumbar cord in a cephalad direction. The degree of displacement was more pronounced if the cervical flexion followed hip flexion rather than hip extension. Hip flexion also moved the lumbar cord in a cephalad direction. However, the difference in cord displacement attributable to different sequences in hip movements were not found to be statistically significant. Cervical flexion elicited a greater cord displacement than traction. CONCLUSION: These findings would advocate that a test that comprises both neck and hip movements would be more sensitive in assessing nerve root movements than one that only uses neck or hip movements. Such a test should also consider the use of various sequences of neck and hip movements.

Animals↗
PubMed1995

No relationship between epidural fibrosis and sciatica in the lumbar postdiscectomy syndrome. A study with contrast-enhanced magnetic resonance imaging in symptomatic and asymptomatic patients.

STUDY DESIGN: Symptomatic patients were retrospectively analyzed and compared with a control group from an ongoing prospective and consecutive study. OBJECTIVES: To determine the presence and extent of epidural fibrosis in patients with and without recurrent sciatic pain after previous lumbar discectomy, contrast-enhanced magnetic resonance images were evaluated and correlated with surgical findings in the symptomatic patients. Recurrent hernia and bony stenosis were ruled out as the probable causative agent, as well as any morphologic explanation other than fibrosis. SUMMARY OF BACKGROUND DATA: Repeat surgical results for patients with the lumbar postdiscectomy syndrome with epidural fibrosis alone are often unfavorable. The pathogenic role of epidural fibrosis, however, has not been established. METHODS: The magnetic resonance images of eight patients with recurrent or persistent sciatic pain after lumbar discectomy were compared with those of eight asymptomatic patients constituting a control group. All were examined with magnetic resonance imaging on a 0.3 T unit before and after intravenous injection of gadolinium-DTPA, and clinically, 6 months to 4 years after surgery. The symptomatic patients subsequently underwent reoperation. RESULTS: Fourteen patients had focal or diffuse epidural fibrosis around the nerve root and/or the thecal sac at the operated level, whereas the postoperative findings for two patients were "normal," one in the operated and one in the control group. No difference between the groups regarding mass effect or affection of the nerve roots or thecal sac was noted. At reoperation of the eight symptomatic patients, fibrosis was the only pathologic finding in all cases except one, in which surgery confirmed the normal finding on magnetic resonance imaging. Six of the eight operated patients had recurrent or persistent symptoms within a year of the reoperation. CONCLUSION: No differences regarding the presence and extent of epidural fibrosis between the symptomatic and asymptomatic patients could be demonstrated with contrast-enhanced magnetic resonance imaging. The role of epidural fibrosis as the causative agent in the lumbar postdiscectomy syndrome is questioned.

Adult↗
PubMed2000

Effect of the transligamentous extension of lumbar disc herniations on their regression and the clinical outcome of sciatica.

STUDY DESIGN: Magnetic resonance imaging of symptomatic herniated lumbar discs was investigated longitudinally and prospectively for the presence of tear in the posterior longitudinal ligament (PLL). OBJECTIVES: To clarify the effect of transligamentous extension through the PLL of herniated disc on its regression and to determine the factors contributing to a successful clinical outcome. SUMMARY OF BACKGROUND DATA: Greater regression of the herniated fragment has been noted with larger initial disc herniations. The exposure of herniated disc materials to the epidural vascular supply through the ruptured PLL has been suspected to play a part in the mechanism of disappearance of the herniated nucleus pulposus. However, it had not been shown clinically. METHODS: Clinical outcomes and magnetic resonance images of 36 patients with symptomatic lumbar disc herniations, treated conservatively, were analyzed. Patients were divided into three groups: subligamentous, transligamentous, and sequestered herniations. The size of the herniated disc was measured by herniation ratio, which is defined as the ratio of the area of herniated disc to that of the thecal sac on the axial view. Factors associated with the natural regression of herniated disc and the successful clinical outcome were explored. RESULTS: Of the 36 herniated discs, 25 decreased in size. Ten (56%) of 18 subligamentous herniations, 11 (79%) of 14 transligamentous herniations, and all 4 (100%) sequestered herniations were reduced in size. The average decreases in herniation ratio of the subligamentous, transligamentous, and sequestered disc groups were 17%, 48%, and 82% respectively. The decrease in herniation ratio was related to the presence of transligamentous extension but was not related to the initial size of herniation. Successful outcome correlated with a decrease in herniation of more than 20%. CONCLUSION: Transligamentous extension of herniated disc materials through the ruptured PLL is more important to its reduction in size than is the initial size of the herniated disc. Decrease in herniation ratio of more than 20% seems to correspond to successful clinical outcome.

Adolescent↗