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PubMed1994

Cerebrospinal fluid protein concentrations related to clinical findings in patients with sciatica caused by disk herniation.

The protein concentration in the cerebrospinal fluid (CSF) is often increased in patients with sciatica, probably due to leaking of plasma proteins through the blood-nerve root barrier into CSF. Positive straight leg raising test, paresis, altered sensibility, reduced reflexes, and type of treatment were related to the CSF protein concentrations in 180 patients with sciatica caused by verified lumbar disk herniation. Significantly higher values of the CSF/serum albumin ratio and the CSF/serum immunoglobulin G ratio were found both in patients with positive straight leg raising test results and paresis compared with patients with no clinical findings. In the patients who had undergone emergency surgery, the same ratio parameters were significantly higher when compared with those who had undergone routine surgery and those had not undergone surgery. Elevated CSF proteins seem to be important indicators of the functional status of the nerve root and a measure of the degree of seriousness of sciatica. The interaction of smoking on CSF proteins was also studied.

Adult↗

PubMed2002

Relationship between severity of lumbar disc disease and disability scores in sciatica patients.

OBJECTIVE: To study the association between the clinical examination and the radiological assessment of lumbar disc disease in patients with sciatica. METHODS: The study included 394 consecutive sciatica patients. The patients' disabilities were evaluated by a visual analog pain scale, the Prolo functional-economic rating scale, the modified Roland-Morris disability questionnaire, and the health-related quality of life short form (SF-36) questionnaire. Radiological imaging findings were independently classified according to the Modic criteria into five groups of increasing severity of disc disease. Stepwise multivariate logistic regression was used to determine which scores were significant independent predictors of a severe disc disease (extrusion or sequestration). RESULTS: Of these patients, 9.6% had no disc disease, 3.3% had a bulging, 11.4% had a protrusion, 68.5% had an extrusion, and 7.1% had a disc sequestration. Statistically significant positive linear associations with the severity of disc disease were found for the leg pain scale, the Roland-Morris and Prolo disability scales, and the SF-36 scores related to physical functioning, physical role, and bodily pain (all P < 0.005). A poor (<5) Prolo score (odds ratio, 2.91; 95% confidence interval, 1.74-4.87), a higher leg pain score (odds ratio, 1.16 per centimeter increase; 95% confidence interval, 1.07-1.27), and a lower low back pain score (odds ratio, 0.90 per centimeter decrease; 95% confidence interval, 0.82-0.98) were retained in the multivariate logistic model as independent predictors of severe disc disease. CONCLUSION: The positive correlation between disability status and imaging findings validates both assessment methods. Routine use of disability scores brings a useful contribution to the assessment of sciatica patients.

Adult↗

PubMed1992

The natural history of sciatica associated with disc pathology. A prospective study with clinical and independent radiologic follow-up.

The purpose of this study was to assess the natural history of sciatica due to lumbosacral nerve root compromise and to evaluate the pathomorphologic changes that accompany the natural resolution of the disease. One hundred sixty-five consecutive patients, 114 males and 51 females, with an average age of 41 years (range, 17-72) and an average duration of symptoms of 4.2 months (range, 1-72) presenting with sciatica thought to be due to lumbosacral nerve root compromise were admitted to the study. The cornerstone of treatment was the serial epidural administration of steroid and local anesthetic by the caudal route on an outpatient basis. Lumbar epidural injection or periradicular infiltration at the appropriate level, confirmed under image intensifier, was the next step before considering surgical decompression. An average of three injections (range, 0-8) was received by each patient. Patients underwent clinical examination and computed tomography. Twenty-three patients (14%) underwent surgical decompression. The remainder were clinically assessed at 1 year after presentation, and 111 were rescanned at the appropriate levels. All conservatively managed patients made a satisfactory clinical recovery: average reduction of pain on the visual analog scale was 94% (range, 45-100), and 64 (76%) of the 84 disc herniations and 7 (26%) of the 27 disc bulges showed partial or complete resolution (chi-square = 20.27, P = 0.0001). Thus a high proportion of patients with discogenic sciatica make a satisfactory recovery with aggressive conservative management, and this recovery is accompanied by resolution of disc herniations in a significant number. Only a small proportion of patients needed surgical decompression.

Adult↗

PubMed1993

Cerebrospinal fluid proteins as indicators of nerve root compression in patients with sciatica caused by disc herniation.

Patients with sciatica caused by lumbar disc herniation were studied to identify biochemical changes in the cerebrospinal fluid related to myelographic findings and clinical observations. One hundred forty-three patients were evaluated by myelography with regard to involvement of the dural sac and the nerve root. A medial group (20 patients) with evidence of dural sac impingement was compared to a lateral group (63 patients) and an extreme lateral group (9 patients) whose condition primarily affected the nerve root. The remaining 51 patients comprised a mixed group with involvement of both the dural sac and the nerve root. The mean cerebrospinal fluid/serum albumin ratio, cerebrospinal fluid/serum immunoglobulin G ratio, and cerebrospinal fluid total proteins showed a significantly increasing trend from the medial through the lateral to the extreme lateral groups. Patients with lateral lumbar disc herniations more often showed neurologic deficits. These results indicate that the elevated cerebrospinal fluid total protein found in the patients with sciatica is due to leaking of plasma proteins primarily from the nerve root into the cerebrospinal fluid. The cerebrospinal fluid proteins may be used as diagnostic parameters of nerve root compression, especially when surgery is a consideration or in patients in whom sciatica is unlikely.

Adolescent↗

PubMed1994

Cyclic sciatica. A case report.

We report a case of endometrioma in the pelvic cavity. A 41-year-old woman presented with a peculiar periodic sciatica associated with her menses. Computed tomography showed an oval-shaped mass in the pelvic cavity compressing the right sciatic nerve. To confirm the diagnosis, hormonal therapy through nose dropping of buserelin acetate was given to stop menstruation. After treatment, her symptoms disappeared completely. When a sciatica is closely related to menses, orthopedic surgeons should consider cyclic sciatica resulting from endometrioma as a differential diagnosis.

Adult↗

PubMed1994

Describing the size of lumbar disc herniations using computed tomography. A comparison of different size index calculations and their relation to sciatica.

STUDY DESIGN: The study compared different methods to measure the absolute and relative size of lumbar disc herniations on computed tomography scans and their relation to sciatica. METHODS: Computed tomography (CT) examinations were done before and at 3 and 24 months after nonoperative treatment in 30 patients with lumbar disc herniations. The size of the herniation was described by different indexes and related to the degree of sciatica. One index was formed by the area of the herniation in relation to the spinal canal (A-index), whereas two indexes were formed by linear measurements of the herniation in relation to the spinal canal in either two (ST-index) or one direction (S-index). RESULTS: Each index was correlated significantly to the degree of sciatica. The area of the herniations decreased markedly over time. CONCLUSIONS: Linear measurements of the herniation in two perpendicular directions provide a practical and accurate way of describing the size of lumbar disc herniations.

Adult↗

PubMed1996

The Maine Lumbar Spine Study, Part II. 1-year outcomes of surgical and nonsurgical management of sciatica.

STUDY DESIGN: The Maine Lumbar Spine Study is a prospective cohort study of patients recruited from the practices of orthopedic surgeons, neurosurgeons, and occupational medicine physicians throughout Maine. OBJECTIVE: To assess 1-year outcomes of patients with sciatica believed to be due to a herniated lumbar disc treated surgically or nonsurgically. SUMMARY OF BACKGROUND DATA: Lumbar spine surgery rates vary by geographic region and may reflect uncertainty about optimal clinical use. METHODS: Eligible consenting patients participated in a baseline interview performed by study personnel and then were mailed follow-up questionnaires at 3, 6, and 12 months. Clinical data were obtained from a physician questionnaire. Outcomes included patient-reported symptoms of leg and back pain, functional status, disability, quality of life, and satisfaction with care. RESULTS: Five hundred seven patients with sciatica, 275 treated surgically and 232 treated nonsurgically initially, were enrolled. Surgically treated patients, on average, had more severe symptoms and had more severe physical and imaging findings than nonsurgically treated patients at entry. Although few surgically treated patients had mild symptoms and few nonsurgically treated patients had severe symptoms, about half in each treatment group had symptoms that fell into a moderate category. At the 1-year evaluation, improvement in symptoms, functional status, and disability were found in both treatment groups. However, surgically treated patients reported significantly greater improvement. For the predominant symptom, either back or leg pain, 71% of surgically treated and 43% of nonsurgically treated patients reported definite improvement (P < 0.001). This effect was even greater after adjustment for differences between treatment groups at entry (relative odds of definite improvement, 4.3; P < 0.001). For patients with moderate symptoms and abnormal physical examination findings, surgical treatment also resulted in greater improvement than nonsurgical treatment. However, there was little difference in the employment or workers' compensation status of patients treated surgically versus nonsurgically (5% vs. 7% unemployed at 1-year follow-up if employed at entry [P = 0.68]; 46% vs. 55% receiving workers' compensation at 1-year follow-up if receiving it at entry [P = 0.30] for surgical and nonsurgical management, respectively). For patients with mild symptoms, the benefits of surgical and nonsurgical treatment were similar. CONCLUSIONS: Although surgically treated patients were on average more symptomatic at entry, there was substantial overlap in symptoms between surgically treated and nonsurgically treated patients. Surgically treated patients with sciatica reported substantially greater improvement at 1-year follow-up. However, employment and compensation outcomes were similar between the two treatment groups, and surgery appeared to provide little advantage for the subset of patients with mild symptoms. These results should be interpreted cautiously, because surgical treatment was not assigned randomly. Long-term follow-up will determine if these differences persist.

Adolescent↗

PubMed1998

Extraspinal causes of sciatica. A case report.

STUDY DESIGN: A case of intrapelvic aneurysm is reported. It is as an example of one of the many extraspinal causes of sciatica. OBJECTIVE: To demonstrate the importance of clinical examination in the assessment of patients with sciatic, despite continuing improvements in methods for imaging the spine. SUMMARY OF BACKGROUND DATA: Extraspinal conditions cause sciatic in a rare but recognized group of patients. Their clinical symptoms can be very similar to those of patients with sciatic from lumbar disc protrusion. METHODS: The clinical appearance, investigation, and treatment of a patient with an internal iliac artery aneurysm causing sciatic are discussed. RESULTS: Surgical treatment of the patient's aneurysm resulted in relief of the symptoms of sciatica. CONCLUSIONS: Although these cases are unusual in isolation, together they represent an important group. When a patient has sciatica, the clinician looks first to the spine for the origin of symptoms. Extraspinal causes are often not considered in the differential diagnosis. This oversight may be compounded by observation of asymptomatic disc protrusions on computed tomographic and magnetic resonance studies. The importance of clinical history and examination in the diagnosis of these lesions cannot be overemphasized.

Aneurysm↗

PubMed1998

An unusual cause of sciatica. A case report.

STUDY DESIGN: This case report illustrates the need to be aware of extraspinal causes of sciatica. A patient with a strangulated sciatic hernia showed the clinical features of sciatic leg pain, intestinal obstruction, and a left gluteal abscess. OBJECTIVE: To highlight the need to examine the course of the sciatic nerve for local pathology when the cause of sciatica is not obvious. SUMMARY OF BACKGROUND DATA: Sciatic herniae are rare. The coexistence of sciatica and a gluteal abscess, caused by a strangulated sciatic hernia, does not appear to have been reported previously. METHODS: A 66-year-old woman with preexisting low back pain and left leg pain was admitted to the hospital with intestinal obstruction and a left gluteal mass. Results of needle aspiration suggested the diagnosis, which was confirmed by laparotomy. The sciatic hernia was repaired via a transabdominal approach. RESULTS: The symptoms of sciatic nerve compression and intestinal obstruction resolved fully after surgery. CONCLUSION: The possibility of local pathology causing sciatic nerve compression should be considered when a patient reports sciatic leg pain, particularly if the presentation is atypical. Intestinal obstruction or the presence of a gluteal mass should suggest the possibility of a sciatic hernia.

Abscess↗

PubMed2001

Periradicular infiltration for sciatica: a randomized controlled trial.

STUDY DESIGN: A randomized, double-blind trial was conducted. OBJECTIVES: To test the efficacy of periradicular corticosteroid injection for sciatica. SUMMARY OF BACKGROUND DATA: The efficacy of epidural corticosteroids for sciatica is controversial. Periradicular infiltration is a targeted technique, but there are no randomized controlled trials of its efficacy. METHODS: In this study 160 consecutive, eligible patients with sciatica who had unilateral symptoms of 1 to 6 months duration, and who never underwent surgery were randomized for double-blind injection with methylprednisolone bupivacaine combination or saline. Objective and self-reported outcome parameters and costs were recorded at baseline, at 2 and 4 weeks, at 3 and 6 months, and at 1 year. RESULTS: Recovery was better in the steroid group at 2 weeks for leg pain (P = 0.02), straight leg raising (P = 0.03), lumbar flexion (P = 0.05), and patient satisfaction (P = 0.03). Back pain was significantly lower in the saline group at 3 and 6 months (P = 0.03 and 0.002, respectively), and leg pain at 6 months (13.5, P = 0.02). Sick leaves and medical costs were similar for both treatments, except for cost of therapy visits and drugs at 4 weeks, which were in favor of the steroid injection (P = 0.05 and 0.005, respectively). By 1 year, 18 patients in the steroid group and 15 in the saline group underwent surgery. CONCLUSIONS: Improvement during the follow-up period was found in both the methylprednisolone and saline groups. The combination of methylprednisolone and bupivacaine seems to have a short-term effect, but at 3 and 6 months, the steroid group seems to experience a "rebound" phenomenon.

Adult↗

PubMed2001

Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: five-year outcomes from the Maine Lumbar Spine Study.

STUDY DESIGN: A prospective cohort study. OBJECTIVE: To assess 5-year outcomes for patients with sciatica caused by a lumbar disc herniation treated surgically or nonsurgically. SUMMARY OF BACKGROUND DATA: There is limited knowledge about long-term treatment outcomes of sciatica caused by a lumbar disc herniation, particularly the relative benefits of surgical and conservative therapy in contemporary clinical practice. METHODS: Eligible, consenting patients recruited from the practices of orthopedic surgeons, neurosurgeons, and occupational medicine physicians throughout Maine had baseline interviews with mailed follow-up questionnaires at 3, 6, and 12 months and annually thereafter. Clinical data were obtained at baseline from a physician questionnaire. Outcomes included patient-reported symptoms of leg and back pain, functional status, satisfaction, and employment and compensation status. RESULTS: Of 507 patients initially enrolled, 5-year outcomes were available for 402 (79.3%) patients: 220 (80%) treated surgically and 182 (78.4%) treated nonsurgically. Surgically treated patients had worse baseline symptoms and functional status than those initially treated nonsurgically. By 5 years 19% of surgical patients had undergone at least one additional lumbar spine operation, and 16% of nonsurgical patients had opted for at least one lumbar spine operation. Overall, patients treated initially with surgery reported better outcomes. At the 5-year follow-up, 70% of patients initially treated surgically reported improvement in their predominant symptom (back or leg pain) versus 56% of those initially treated nonsurgically (P < 0.001). Similarly, a larger proportion of surgical patients reported satisfaction with their current status (63% vs. 46%, P < 0.001). These differences persisted after adjustment for other determinants of outcome. The relative advantage of surgery was greatest early in follow-up and narrowed over 5 years. There was no difference in the proportion of patients receiving disability compensation at the 5-year follow-up. The least symptomatic patients at baseline did well regardless of initial treatment, although function improved more in the surgical group. CONCLUSIONS: For patients with moderate or severe sciatica, surgical treatment was associated with greater improvement than nonsurgical treatment at 5 years. However, patients treated surgically were as likely to be receiving disability compensation, and the relative benefit of surgery decreased over time.

Adult↗

PubMed2002

Outcome after chronic sciatica as the only reason for lumbar microdiscectomy.

There are only a few long-term studies on microsurgical disc operations, and none concentrated on long-term follow-up of therapy-resistant sciatica. A total of 258 patients whose only neurologic symptoms were sciatica were included in this study. Patients were operated on between 1990 and 1997. All outcome results have been performed by an independent reviewer. The mean follow-up period was 7.3 years (range 4-11 years). At follow-up 25% of the patients were free of pain, 66% demonstrated marked improvement, and 9% had either no improvement or worsening of pain. At follow-up 65% of the patients reported returning to their original occupation or being able to go into retirement without hindrance. A total of 15% required changing of profession following discectomy (75% of these patients applying for early retirement were rejected), 6% were incapacitated and unable to work, and 14% were forced into early retirement. Patients with a history of sciatica longer than 3 months acquired failed back surgery syndrome considerably more often than those <3 months (p = 0.005).

Adult↗

PubMed2005

Centralization: its prognostic value in patients with referred symptoms and sciatica.

STUDY DESIGN: Prospective, comparative cohort study. OBJECTIVE: To investigate the prognostic significance of centralization in patients with subacute sciatica and referred symptoms. SUMMARY OF BACKGROUND DATA: Previous studies have shown that centralization occurs commonly in the nonspecific low back population, and its occurrence is associated with a good prognosis. The phenomenon has never been evaluated in a population with sciatica and referred symptoms. METHODS: The sample pool was 104 consecutive patients referred for investigation of possible disc herniation. Of these patients, 60 were recruited into the study and underwent a standardized mechanical evaluation using repeated end-range movements, while symptom response was monitored to expose 2 groups: centralization group (CG) and noncentralization group (NCG). All patients were treated in the same way and were followed for one year. If patients did not have improvement surgery was considered. Outcomes included back and leg pain, disability, Nottingham Health Profile, and surgical outcome. RESULTS: There were 25 patients who were classified in the CG, 35 in the NCG, and other baseline characteristics were similar between groups. At 1, 2, and 3 months, the CG had significantly better outcomes than the NCG. At 2 months, the CG had more improvements in leg pain (P = 0.007), disability (P = <0.001), and Nottingham Health Profile (P = 0.001). After 1 year, disability was less in the CG (P = 0.029). In the CG, 3 patients underwent surgery, in the NCG, 16 (P = 0.01). The odds ratio for surgery in the NCG was 6.2. CONCLUSION: Patients with sciatica and suspected disc herniation who have a centralization response to a mechanical evaluation will have significantly better outcomes. Patients who do not have centralization will be 6 times more likely to undergo surgery.

Adolescent↗

PubMed2005

The treatment of disc herniation-induced sciatica with infliximab: results of a randomized, controlled, 3-month follow-up study.

STUDY DESIGN: A randomized controlled trial. OBJECTIVES: To evaluate the efficacy of infliximab, a monoclonal antibody against tumor necrosis factor (TNF)-alpha in a randomized controlled setting. SUMMARY OF BACKGROUND DATA: Recently, we obtained encouraging results in an open-label study of infliximab in patients with disc herniation-induced sciatica. Furthermore, the results of experimental studies support the use of infliximab in sciatica. Therefore, we initiated a randomized, controlled trial (FIRST II, Finnish Infliximab Related STudy) to confirm the efficacy of a single infusion of infliximab for sciatic pain. METHODS: Inclusion criteria were unilateral moderate to severe sciatic pain with an MRI-confirmed disc herniation concordant with the symptoms and signs of radicular pain. Patients had to be candidates for discectomy, as evaluated by an independent orthopedic surgeon. Forty patients were allocated to a single intravenous infusion of either infliximab 5 mg/kg or placebo. Assessments at baseline and various time points included clinical examination with measurement of straight leg raising restriction; questionnaires related to subjective symptoms (leg and back pain by 100-mm visual analog scale, Oswestry disability); sick leaves; number of discectomies; and adverse effects possibly related to treatment. The primary endpoint was a reduction in leg pain from baseline to 12 weeks, which was analyzed using a Mann-Whitney U test and repeated-measures analysis. RESULTS: A significant reduction in leg pain was observed in both groups, with no significant difference between treatment regimens. Similar efficacy was observed between treatment groups for secondary endpoints. Seven patients in each group required surgery. No adverse effects related to treatment were encountered. CONCLUSIONS: The results of this randomized trial do not support the use of infliximab for lumbar radicular pain in patients with disc herniation-induced sciatica.

Adult↗

PubMed2006

The treatment of disc-herniation-induced sciatica with infliximab: one-year follow-up results of FIRST II, a randomized controlled trial.

STUDY DESIGN: A randomized controlled trial. OBJECTIVES: To evaluate the long-term efficacy of infliximab, a monoclonal antibody against tumor necrosis factor alpha (TNF-alpha), in patients with acute/subacute sciatica secondary to herniated disc. SUMMARY OF BACKGROUND DATA: The results of experimental studies and our open-label trial support the use of infliximab in sciatica. Here we report the 1-year results of a randomized controlled trial (FIRST II, Finnish Infliximab Related STudy) evaluating the efficacy and safety of a single infusion of infliximab for sciatic pain. METHODS: Inclusion criteria were unilateral sciatic pain with a disc herniation concordant with the symptoms and signs of radicular pain. Patients had to be candidates for discectomy. Criteria for discectomy included (in addition to a symptomatic disc herniation on MRI) neural entrapment (straight leg raising [SLR] < or =60 degrees ) with either a short-term (2-4 weeks) severe or long-term (4-12 weeks) moderate leg pain. Forty patients were allocated to a single intravenous infusion of either infliximab 5 mg/kg or placebo. Differences in the clinical examination parameters (straight leg raise [SLR], muscle strength, sensory defects, tendon reflexes), patient-reported symptoms (leg and back pain using a visual analog scale [VAS], Oswestry disability, quality-of-life [RAND-36]), sick leaves, number of discectomies, and adverse effects between the two treatment groups over the 1-year follow-up were compared using Mann-Whitney U test or Student's t test, repeated-measures analysis, or Cox proportional hazards model. Logistic regression was used to assess the predictors of good response. RESULTS: Sixty-seven percent of patients in the infliximab group reported no pain at 52 weeks compared with 63% in the control group (P = 0.72). Similar efficacy was observed between treatment groups for other outcomes. Eight patients in each group required surgery. Three nonserious adverse reactions were encountered in the infliximab group. The response (irrespective of the treatment) was significantly better with shorter symptom duration and less SLR restriction at baseline. Patients in the infliximab group appeared to especially benefit in cases of a L4-L5 (or L3-L4) herniation and if a Modic change was colocalized at the symptomatic level. CONCLUSIONS: Although the long-term results of this randomized trial do not support the use of infliximab compared with placebo for lumbar radicular pain in patients with disc herniation-induced sciatica, further study in a subgroup of patients with L4-L5 or L3-L4 herniations, especially in the presence of Modic changes, appears to be warranted.

Acute Disease↗

PubMed1998

Warm and cold sensory thresholds in patients with unilateral sciatica: C fibers are more severely affected than A-delta fibers.

OBJECTIVES: In order to evaluate if nerve root compression or inflammation is the most important pathogenetic mechanism in lumbar radicular pain, we investigated unmyelinated C-fiber function (warm sensation) and myelinated A-delta fiber function (cold sensation) in patients with unilateral L5 or S1 sciatica. MATERIAL AND METHODS: Forty consecutive patients with clinical and radiological evidence of unilateral L5 (n = 29) or S1 (n = 11) sciatica were studied. The warm and cold sensory thresholds (Somedic thermotest, method of limits) were measured on the anterolateral leg (L5 dermatome) and on the calf (S1 dermatome) on both sides. RESULTS: Warm thresholds were significantly higher on the symptomatic side compared to the non-symptomatic side (8.4+/-3.0 vs 6.2+/-2.5 degrees C, P < 0.0005) in the affected dermatome. In a subgroup with confirmed disk herniation at surgery (32 of the 34 operated), significant differences between the symptomatic and the non-symptomatic side for the affected dermatome, were found for both warm (P < 0.0005) and cold (P = 0.003) thresholds. No threshold difference was seen in patients with disk herniations contained within the outer annulus fibrosis (n = 22) compared to those with non-contained herniations (n = 10). CONCLUSIONS: Patients with unilateral sciatica and L5 or S1 nerve root involvement had increased warm thresholds suggesting impaired C-fiber function. Cold thresholds were significantly elevated in a subgroup with operatively confirmed disk herniation. Because myelinated axons are affected more by compression than unmyelinated ones, our results suggest that nerve root inflammation is more important than compression per se in the generation of sciatic pain.

Adult↗

PubMed2003

Epidural corticosteroid injections for sciatica: a randomised, double blind, controlled clinical trial.

OBJECTIVE: To determine the efficacy of epidural corticosteroid injections for sciatica. METHODS: Three epidural injections (two day intervals) of 2 ml prednisolone acetate (50 mg) or 2 ml isotonic saline were administered to patients with sciatica presumably due to a disk herniation lasting 15-180 days. Self evaluation was the main judgment criterion at day 20. Patients who recovered or showed marked improvement were considered as success. Pain measured by VAS, the SLR test, Schober's test, Dallas pain questionnaire, and the Roland-Morris index were evaluated at days 0, 5, 20, and 35. Only analgesics were authorised, patients requiring non-steroidal anti-inflammatory drugs (NSAIDs) before day 20 were considered as failure. RESULTS: 42 patients were included in the control group (CG), 43 in the steroid group (SG). On an intention to treat analysis 15/42 (36%) in the CG and 22/43 (51%) in the SG (p=0.15) were considered as success (difference 15.5%, 95% CI (-5.4 to 36.3)). Among the 48 failures, 14 patients (6 CG, 8 SG) required NSAIDs, 3 (2 CG, 1 SG) required surgery, and 7 (3 CG, 4 SG) other treatments. On analysis according to protocol, in 74 remaining patients 12/35 (34%) in the CG and 22/39 (56%) in the SG (p=0.057) were considered as success (difference 22.1%, 95% CI (0.0 to 44.2)). For all secondary end points intragroup improvement with time was significant, but intergroup differences were not. CONCLUSION: The efficacy of isotonic saline administered epidurally for sciatica cannot be excluded, but epidural steroid injections provide no additional improvement.

Adult↗

PubMed1998

Annular tears and disk herniation: prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica.

PURPOSE: To evaluate the prevalence and radiologic findings of annular tear (especially of contrast material enhancement), bulging disk, and disk herniation on T2-weighted and gadolinium-enhanced T1-weighted magnetic resonance (MR) images in people without low back pain (LBP) or sciatica. MATERIALS AND METHODS: Thirty-six volunteers without LBP and/or sciatica (18 with no symptoms in their lifetime and 18 who were pain free for at least 6 months) were examined with sagittal and axial T2-weighted fast spin-echo (SE) and sagittal gadolinium-enhanced T1-weighted fast SE imaging. The prevalence and MR findings of bulging disk, focal protrusion, extrusion, and nonenhancing or enhancing annular tears were assessed. RESULTS: The prevalence of bulging disk and focal disk protrusion was 81% (29 volunteers) and 33% (12 volunteers), respectively. There were no extrusions. Twenty-eight annular tears were found in 20 patients (56%); 27 tears (96%) also showed contrast enhancement. CONCLUSION: Annular tears and focal disk protrusions on MR images, with or without contrast enhancement, are frequently found in an asymptomatic population. Extruded disk herniation, displacement of nerve root, and interruption of annuloligamentous complex are unusual findings in an asymptomatic population and can be more closely related to patients with LBP or sciatica.

Adult↗