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PubMed2006

Short-term efficacy of intravenous pulse glucocorticoids in acute discogenic sciatica. A randomized controlled trial.

STUDY DESIGN: Double-blinded randomized controlled trial. OBJECTIVE: To test the short-term efficacy of a single intravenous (IV) pulse of glucocorticoids on the symptoms of acute discogenic sciatica. SUMMARY OF BACKGROUND DATA: The use of glucocorticoids in the treatment of acute discogenic sciatica is controversial. A potential advantage of the IV pulse therapy is the ability to distribute high glucocorticoid concentrations to the area surrounding the prolapsed disc without the risks and inconveniences of an epidural injection. METHODS: Patients with acute sciatica (<6-week duration) of radiologically confirmed discogenic origin were randomized to receive either a single IV bolus of 500 mg of methylprednisolone or placebo. Clinical evaluation was performed in a double-blind manner on days 0, 1, 2, 3, 10, and 30. The primary outcome was reduction in sciatic leg pain during the first 3 days following the infusion; secondary outcomes were reduction in low back pain, global pain, functional disability, and signs of radicular irritation. The analysis was performed on an intent-to-treat basis using a longitudinal regression model for repeated measures. RESULTS: A total of 65 patients were randomized, and 60 completed the treatment and the follow-up assessments. A single IV bolus of glucocorticoids provided significant improvement in sciatic leg pain (P = 0.04) within the first 3 days. However, the effect size was small, and the improvement did not persist. IV glucocorticoids had no effect on functional disability or clinical signs of radicular irritation. CONCLUSIONS: Although an IV bolus of glucocorticoids provides a short-term improvement in leg pain in patients with acute discogenic sciatica, its effects are transient and have small magnitude.

Double-Blind Method↗

PubMed2006

Association between sciatica and microbial infection: true infection or culture contamination?

STUDY DESIGN: Discs were cultured during discectomy from patients with back pain, sciatica, and radiologic evidence of disc herniation causing nerve root compression. OBJECTIVE: To investigate the claim of culpability of bacteria in causing the local inflammatory process seen in patients with disc herniation and radiculopathy. SUMMARY OF BACKGROUND DATA: Bacteria have been cultured from intervertebral discs of patients with sciatica. An infectious etiology for sciatica could have a dramatic effect on treatment options for this common problem. METHODS: To minimize the risk of contamination, the surgeon performed processing and culturing procedures intraoperatively under stringent sterile conditions. Immediately following disc excision, the specimens were divided into 4 pieces, and cultured in various aerobic and anaerobic culture mediums that were incubated for 2 weeks. RESULTS: The 120 specimens from 30 patients underwent bacterial culture growth: 116 were sterile, an 4 aerobic cultures (2 patients) grew coagulase-negative staphylococci, suggestive of contamination. CONCLUSIONS: These results refute the hypothesis that microbial infection plays a role in the pathogenesis of sciatica. It is possible that bacterial growth from discs reported in previous studies was at least partly related to contamination, which we painstakingly avoided by application of rigorous aseptic techniques.

Adult↗

PubMed1992

[Clinical diagnosis of sciatica].

Sciatica is diagnosed on purely clinical grounds. The initial clinical examination provides the main elements for an aetiological diagnosis. It makes it possible in certain cases to take urgent decisions: to prescribe imaging methods or specific treatments. When examining patients suffering from sciatica, the clinician must aim at gathering elements of answers to the following questions: Is the diagnosis of sciatica ascertained? Is it a common vertebral disc sciatica? Is surgery urgently required? What is the personal and medico-social context?

Diagnosis, Differential↗

PubMed1990

A prospective study of patients with sciatica. A comparison between conservatively treated patients and patients who have undergone operation, Part II: Results after one year follow-up.

The prospective study included 122 sciatica patients who had not undergone operation (NOPs) and 220 sciatica patients who had undergone operation (OPs); all had been examined by rhizography. The follow-up study was done on 110 (90%) of the NOPs and 212 (96%) of the OPs. The NOPs were divided into two groups: 30 patients with pathologic rhizography (PR) and 80 patients with negative rhizography (NR). Pain-, ADL-, and occupation-handicap indices showed that after the 1 year follow-up the OP group had the best result and the NR group the lowest result. The PR group had nearly as good a result as the OP group. Thus, sciatica patients are candidates for conservative therapy, even though they have pathologic findings in rhizography, if the symptoms are mild. To improve therapeutic outcome, more accurate diagnostic tools are needed to develop specific therapy especially for those sciatica patients with negative rhizography.

Adult↗

PubMed1985

[Sciatica and other low-back disorders in private practice: extent of the problem and therapeutic approaches].

Using data collected by INSERM in a 1975 survey among French general practitioners and specialists in private practice, the reporting of sciatica and low back pain (LBP) was studied, as well as doctors' diagnoses and therapeutic approaches. Only 0.7% of patients were reported as having sciatica, while 2.8% were reported with LBP. These percentages suggest, respectively, 1.5 and 6.5 million consultations with private practitioners. The prevalence of sciatica was estimated at 8%. There was no urban-rural difference in the consultation rate; three-quarters of the patients were seen by GPs. The frequency of LBP was higher among the employed, particularly among manual workers. Referrals for additional examinations were nearly twice as high for sciatica as for LBP. GPs prescribed more medicines, and more sick leave, than specialists, but made fewer referrals for additional examination, probably because the patients seen were different, or were at a different stage of disease. It is concluded that the formulation of standards of care specific to each level of care might be useful.

Adolescent↗

PubMed1984

[Usefulness of cerebrospinal fluid in patients with sciatica].

The authors report the data of the analysis in cephalo-rachidial fluid during 162 sciaticas. 52,5% cases have a normal albuminorachidia. There is a correlation between the clinical findings bur none with the evolution before punction and the albuminorachia. When it is found more than 0,40 g/l there are abnormalities on the myelographic-examination and the patients are more often operated on. In fact the analysis of the cephalo-rachidial fluid is not very useful in common sciaticas. It is necessary to follow up cases where more than five cells (by mm3) are found because they might become multiple sclerosis (3 cases one year later). A determination of the beta-2-microglobulin was performed because it is an excellent criteria of inflammation, in the cephalo-rachidial fluid. During sciatica its level is regularly normal (24 normal over 30); but is may increase in other pathological situations which, at the beginning, look like sciaticas.

Adolescent↗

PubMedDate not supplied

[Results of the medical treatment of sciatica of disk origin in a hospital melieu].

In an attempt to find out the becoming of patients with sciatica who have been medically treated, 112 previously hospitalized patients have been questioned and examined by the same physician, two to eight years later. The criteria used were the presence of pain and the level of social and professional activity. The good and excellent results (58%) were slightly better than the poor results and failures (42%). However, painful sequelae were very frequent (83.5%) in the form of lumbago, sciatica or a combination of both, and obliged one subject out of three--manual workers or laborers--to change their occupation. Neither age nor sex, ethnic origin nor occupation, nor the circumstances surrounding the onset (whether or not an accident at work) influenced the course. On the other hand, a long standing history of sciatica decreases the chances of a cure and the older the history, the worse the long-term prognosis. Thus, it seems reasonable not to prolong medical treatment over two months and to advise surgery after a well conducted course of treatment in the recurring cases of sciatica, and in those that do not respond to the usual therapeutic measures. To persist in following a medical treatment threatens to leave definite sequella from prolonged radicular compression.

Adult↗

PubMed1981

[Treatment of intervertebral disk sciatica by chemonucleolysis. Analysis of 56 cases].

The authors report 56 cases of sciatica treated by chemonucleolysis with follow-up ranging from six months to two years. All patients presented with manifest clinical symptomes of intervertebral disc herniation, and the diagnostic was verified by myelography. In all cases myelographic findings corresponded to clinical topography when the topography was precisely defined. This group of patients, therefore, was highly selected, and the authors attempted to eliminate excluded herniations when the myelographic anomaly appeared at a distance from the intervertebral space. Cases of sciatica caused by stenosis, paralytic sciatica, and pure lumbar pain were not treated in this study. At the end of the second month, 70 percent of patients obtained good results; the authors, believe, therefore, that failure of treatment can be ascertained by the eighth week. Thirteen of the fifteen treatment failures in this study were operated. Results of this surgery performed after chemonucleolysis were similar to results obtained from surgery performed as initial treatment. No serious complications were observed. Chemonucleolysis, therefore, appears to be an effective means of treatment for sciatica caused by intervertebral disc herniation. Based on their own experience and reports in the literature, the authors believe that chemonucleolysis is the ultimate stage of conservative treatment when classical measures have failed. In addition, the authors' experience and careful review of the literature has shown that serious iatrogenic accidents are exceptionally rare and can be avoided by the use of rigorous technique.

Adult↗

PubMedDate not supplied

[Sciatica in the elderly. Apropos of 27 cases operated after the age of 70].

From a study of 27 operations for common vertebral sciatica in the elderly, certain specific features stand out. L5 sciatica is predominant though curiously, the pain relieving posture is less frequent than in the S1 variety. The condition is usually most painful at night. In 50% of cases there is a motor deficit which to a great extend determines the decision to operate. Finally, there is very good correlation between clinical features and the discovery of a prolapsed disc. Osteoarthrotic lesions are much more common than in the general sciatica population but the disc protrusion always keeps its localising value. Surgical intervention reveals that the disc plays an equally important role at this age as a prolapsed disc was found in 26 cases (11 extruded herniated discs and 2 ruptured). These lesions are less common in the general sciatica population. In about two thirds of patients a herniated disc alone is found and in the others, it is associated with osteoarthrotic lesions although these do not appear to compromise the success of the operation. Amongst the 9 post-operative complications, there was one death due to pulmonary emboli and 2 cases of reflex algodystrophy of the foot on the operated side. With a mean delay of more than 1 year, a frank improvement was noted in 85% of cases as against 80% immediately following surgery. Only one case of recurrence was reported.

Age Factors↗

PubMed1994

Pain control with morphine for vertebral metastases and sciatica in advanced cancer patients.

Morphine was administered to 56 advanced cancer patients; of that number spinal metastases had induced bone pain in 28 and malignant tumors had induced sciatica in 28. The sciatica was caused in 16 patients by direct invasion of the sacral plexus, in four by lumbar bone metastases, and in eight by pelvic bone metastases. Spinal bone pain was controlled adequately with morphine. However, sciatica required larger dosages of morphine than did bone pain. Among the group with sciatica, rectal cancer patients needed larger dosages of morphine than the other cancer patients. Even with high doses of morphine, it was occasionally difficult to control neuropathic pain of the sciatic nerve caused by intrapelvic cancer.

Adult↗

PubMed1997

[Sciatica caused by avulsion of the vertebral limbus in children].

PURPOSE OF THE STUDY: Sciatica is very rare in children. We report a particular from due to traumatic avulsion of the posterior vertebral limbus. The purpose of this study was to give the principal clinical and radiological aspects of this entity and to discuss the treatment which should be different from that of common adult disk herniation. MATERIALS: From 1980 to 1992, 10 children were examined for a sciatica (7 boys and 3 girls aged from 10 years 1 month to 15 years 2 months). Sciatica appeared in all cases during sport activities and sometimes after a sport accident. Lumbar spine stiffness was encountered in all cases. Radiculalgia was unilateral in 7 cases, bilateral in 3 cases, in L5 territory in 3 and S1 in 7 cases. 4 children had deficitary neurological signs: 3 abolitions of achilles reflex, 1 weakness of foot dorsi-flexors. Standard x-rays showed in 4 cases the avulsed fragment in the vertebral canal. Spondylosis was encountered in 3 cases and spondylolisthesis in one case. Diagnosis was possible in all cases with CT Scan, M.R.I., when done showed a normal disk signal. Three children were managed by a conservative treatment by rest or brace. Seven had a surgical treatment: resection of the avulsed fragment in 6 and total diskectomy in one. The mean follow-up was five years (2 to 8 years). RESULTS: There was no complication. At last follow-up all children had a good result without sciatica recurrence. DISCUSSION: Many factors allow us to think that avulsion of the vertebral rim in children is of traumatic origin. CT Scan is the best exploration for this particular lesion. It enabled evaluation of fragment volume and location. Magnetic resonance imaging showed uninjured disks. Removal of the avulsed fragment without diskectomy seems possible in children.

Adolescent↗

PubMed1997

Cerebrospinal fluid protein concentrations in patients with sciatica caused by lumbar disc herniation: an investigation of biochemical, neurologic, and radiologic predictors of long-term outcome.

We studied 180 adult patients admitted to the Neurological Department, Haukeland Hospital in Bergen, Norway, for a period of 5 years from 1984 to 1988. One hundred fifty-seven patients were followed up 3.9-9.0 years after admittance to the Neurological Department. The purpose of this study was to find out if the total cerebrospinal fluid (CSF) protein concentration could predict the outcome of lumbar disc surgery or conservative treatment in patients with sciatica. Neurologic and radiologic parameters were also included in the investigation. The increase of the CSF total protein concentration in sciatica without spinal block is assumed to be due to leak of plasma proteins into the CSF from the nerve root. A relationship between CSF protein concentrations and certain clinical parameters has been found. At myelography, 10 ml of CSF was collected for analysis. The patients were evaluated for involvement of the nerve root and/or the dural sac, respectively. The neurologic parameters investigated were: straight leg raising tests, paresis, disturbances of sensibility, and altered reflexes. At follow-up, the patients were asked to fill in questionnaires concerning job function, sick leave or disability pension, subjective physical disability and pain perception, and a clinical examination with the same neurologic parameters was performed. Elevated CSF total protein concentration was related to chronic leg pain, leg pain, and subjective physical disability at follow-up. Nonoperated women reported higher subjective physical disability scores and were more often on sick-leave or disability pension than were men at follow-up. Lateral prolapses were associated with good job function outcome and less risk for sick-leave or disability pension. Reduced lower extremity reflexes, laterally located disc herniation and elevated CSF total protein concentration were associated with a favorable long-term outcome in patients with sciatica. CSF proteins as objective measures on nerve root injury are discussed. CSF total protein concentration can be regarded as an indicator of the functional status of the nerve root and a prognostic factor in patients with sciatica.

Adult↗

PubMedDate not supplied

[Arthrotic sciatica caused by radicular compression of osteophytic origin in the lateral recess. Apropos of 18 cases].

The authors report 18 cases of arthrosic sciatica due to toot compression in the lateral recess by posterior corporeal and/or posterior apophyseal osteophytosis. The authors study the clinical and radiological characteristics that may indicate the diagnosis and discuss the different mechanisms by which vertebral arthrosis can lead to radicular compression. When surgery is necessary because of the persistent nature of the sciatica, a broader approach should be undertaken than that required for excision of the disc, in order to explore fully the roots, the multiplicity of possible compression sites being one of the essential characteristics of these cases of arthrosic radiculopathy. Study of the literature and of the series of sciatica patients operated upon by the authors shows that although discal hernia is far from being the most frequent cause of common sciatica, arthrosic compression is a cause that cannot be ignored, especially in aged subjects.

Female↗

PubMed1991

Piriformis muscle syndrome: an underdiagnosed cause of sciatica.

This is a retrospective review of 26 patients with sciatica due to the piriformis muscle syndrome. Most patients had pain in the buttock area and sciatica, and most experienced difficulty walking and sitting, even for short periods of time. Reproduction of the sciatica upon deep palpation, either by gluteal or rectal route, was diagnostic. Reproduction of sciatica occurred in 92% of the patients upon deep digital palpation and in 100% of the patients upon rectal or pelvic examination. Other signs were helpful but not consistent. After the appropriate diagnosis, the treatment was relatively easy and rewarding. This study emphasizes that the diagnosis of piriformis muscle syndrome is clinical; without the appropriate clinical examination, it can be easily misdiagnosed.

Adult↗

PubMed2006

Magnetic resonance neurography in extraspinal sciatica.

BACKGROUND: Sciatica without evidence of lumbosacral root compression is often attributed to piriformis syndrome. However, specific diagnostic tools have not been available to demonstrate sciatic nerve entrapment by the piriformis muscle. OBJECTIVE: To evaluate the use of magnetic resonance (MR) neurography in identifying abnormalities of the sciatic nerve in patients with unexplained sciatica. DESIGN: Case series from a retrospective medical record review. PATIENTS: Fourteen patients with sciatic distribution pain and normal results on MR imaging for lumbosacral radiculopathy were referred for MR neurography of the lumbosacral plexus and sciatic nerves. RESULTS: In 12 patients, MR neurography demonstrated increased fluid-attenuated inversion recovery signal in the ipsilateral sciatic nerve. In most patients, this abnormal signal was seen at the sciatic notch, at or just inferior to the level of the piriformis muscle. To date, 4 patients have undergone surgical decompression, with excellent relief of symptoms in 3 of them. CONCLUSION: Magnetic resonance neurography often identifies an abnormal increased signal in the proximal sciatic nerve in patients with extraspinal sciatica and allows more accurate diagnosis of sciatic nerve entrapment in suspected cases.

Adult↗

PubMed1995

Severe sciatica: a 13-year follow-up of 342 patients.

This study involved 342 patients hospitalized because of severe, persistent sciatica suggestive of a lumbar intervertebral disc herniation. After standard clinical evaluation, EMG and myelography, 220 patients underwent lumbar discectomy. The remaining 122 patients were treated conservatively. Follow-up examinations were arranged after 1, 5 and 13 years. The study focused on the rehabilitation outcome in general and differences in outcome between the two treatment groups. Several indicators showed a rather poor outcome for sciatica patients during the 13-year follow-up period. In the operated group 16% had been re-operated because of lumbar disc herniation. True recurrence of herniation (same level and side) occurred in 8%. In the conservatively treated group 14% had undergone spinal surgery. Nearly 70% of the patients still reported sciatica. Self-assessed levels of low back pain were "no change/worse" for 19% in the operated group and for 44% in the conservatively treated group. In both the study groups, nearly 40% of the subjects had retired on disability pensions.

Activities of Daily Living↗

PubMed1980

Stenosis of the lumbar vertebral canal and sciatica.

Stenosis of the vertebral canal is a form of compressive stenosis in contrast to transport stenosis of vessels or other channels. The concept, definition and pathomorphological properties are discussed. As it is a form of compressive stenosis, the diagnosis is based on measurements of diameters rather than of cross-sectional surfaces. The biomechanical action of compressive stenosis is compression of the fixed living content at two opposite sites or at all sites. The special properties of sciatica in stenosis are described and presented in tabular form. Some properties of neurogenic intermittent claudication (I. Cl.) in the presence of stenosis are discussed. There is a predominance of sciatica at rest and of motor weakness during walking. The mechanism of neurogenic I. Cl. is obscure. Stenosis of the lumbar vertebral canal is one of the conditional determinants of I. Cl. The data presented in this paper demonstrate, however, that stenosis is not an absolute determinant of I. Cl. and that its production depends on the combination with other determinants. The theory is advanced that other determinants may be related to changes in the caudal nerve roots due to either constitutional properties or to subclinical changes induced by ageing and chronic wear and tear, and compression and traction in the area of stenosis during various bodily activities. Suppression of sciatica during I. Cl. is a phenomenon which is particularly difficult to explain.

Anthropometry↗

PubMed1990

Intradiscal injection of triamcinolone hexacetonide for acute, subacute, and chronic sciatica. Results at 3 months an open-prospectus study of 30 cases and review of the literature.

The authors report an open study of 30 cases of intradiscal injection of triamcinolone hexacetonide in the treatment of sciatica. The patients were monitored at months 1 and 3. The results were judged to be good in 36.6% of the cases, moderate in 36.6% and poor in 26.7% of the cases. Two adverse effects were reported: 1 case of reversible urinary retention and 1 case of deficiency of the dorsiflexor muscles of the foot. The good results reported in previous series were only found in this study when the indications were restricted to certain favourable prognostic factors: duration of sciatica less than 6 months and CAT-scan appearance of discal hernia. This technique has the advantage of being simple, economical and nonallergic. On the basis of the encouraging results of the initial series, this technique should be considered as an interesting therapeutic alternative in sciatica. Larger series and double-blind studies, however, are necessary to confirm the initial results.

Acute Disease↗