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At least 145 records · Page 8Linked to original sources

PubMed2005

Prolonged conservative treatment or 'early' surgery in sciatica caused by a lumbar disc herniation: rationale and design of a randomized trial [ISRCT 26872154].

BACKGROUND: The design of a randomized multicenter trial is presented on the effectiveness of a prolonged conservative treatment strategy compared with surgery in patients with persisting intense sciatica (lumbosacral radicular syndrome). METHODS/DESIGN: Patients presenting themselves to their general practitioner with disabling sciatica lasting less than twelve weeks are referred to the neurology outpatient department of one of the participating hospitals. After confirmation of the diagnosis and surgical indication MRI scanning is performed. If a distinct disc herniation is discerned which in addition covers the clinically expected site the patient is eligible for randomization. Depending on the outcome of the randomization scheme the patient will either be submitted to prolonged conservative care or surgery. Surgery will be carried out according to the guidelines and between six and twelve weeks after onset of complaints. The experimental therapy consists of a prolonged conservative treatment under supervision of the general practitioner, which may be followed by surgical intervention in case of persisting or progressive disability. The main primary outcome measure is the disease specific disability of daily functioning. Other primary outcome measures are perceived recovery and intensity of legpain. Secondary outcome measures encompass severity of complaints, quality of life, medical consumption, absenteeism, costs and preference. The main research question will be answered at 12 months after randomization. The total follow-up period covers two years. DISCUSSION: Evidence is lacking concerning the optimal treatment of lumbar disc induced sciatica. This pragmatic randomized trial, focusses on the 'timing' of intervention, and will contribute to the decision of the general practictioner and neurologist, regarding referral of patients for surgery.

Humans↗

PubMed1989

Risk factors for low back pain and sciatica.

So far, eight prospective studies and 50 cross-sectional or retrospective studies have focused on risk factors for low back syndromes. Half of these have been published during the 1980s. Hard physical work and, in particular, frequent lifting and postural stress are likely to result in disc degeneration, low back pain and sciatica. Physical strain may also have prophylactic effects, as physical leisure activity and muscular strength are negatively associated with the risk of low back pain. Much evidence points to driving motor vehicles being causally associated with low back pain and sciatica. A probably causal relationship exists between body height and risk of sciatica, but height is not necessarily predictive of other types of low back pain. Obesity, smoking, psychological distress and poor general health also carry increased risk of low back pain, but their causal role is questionable. Although none of the suspected risk factors can be described as having been conclusively investigated epidemiologically, the results of published studies show that there are modifiable factors contributing to low back pain. The overall potential of primary prevention is great if adequate tools for intervention can be developed.

Back Pain↗

PubMed1999

Are tennis players at increased risk for low back pain and sciatica?

OBJECTIVE: Tennis practiced intensively is generally held to be a risk factor for low back pain. The objective of our study was to evaluate the prevalence of low back pain with or without sciatica during the last week in tennis players versus controls. PATIENTS AND METHODS: During an international tennis competition held in Brest, France, ten physicians or medical students interviewed 633 spectators older than 18 years and divided them into tennis players and controls. The sample size was selected to allow detection of a twofold increase in the risk of low back pain in tennis players (with alpha = 5% and 1-beta = 80%). RESULTS: Of the 633 subjects, 388 were and 245 were not tennis players. There were 421 men with a mean age of 37 +/- 13.7 years and 212 women with a mean age of 34.3 +/- 12.7. Among the men, 49 of the 281 tennis players (17.4%) reported low back pain during the last week versus 26 of the 140 controls (18.6%). Corresponding figures in women were 20 of 107 tennis players (18.7%) and 29 of 105 controls (27.6%). Sciatica was not more common in tennis players (men, 20 of 281 tennis players [7.1%] versus 6 of 140 controls [4.3%]; women, 8 of 107 tennis players [7.5%] versus 10 of 105 controls [9.5%]). None of the differences between tennis players and controls were significant. The number of hours spent playing tennis per week was similar in tennis players with and without low back pain. CONCLUSION: Our interview-based cross-sectional study found no evidence that playing tennis involves a higher risk of low back pain with or without sciatica.

Adolescent↗

PubMed1999

Reasons for rheumatology department admission in 125 patients with disk-related sciatica.

OBJECTIVES: To identify medical and nonmedical reasons for admission of disk-related sciatica patients. PATIENTS AND METHODS: 125 patients were evaluated prospectively using a 25-items questionnaire, including seven items on medical reasons, four on psychological reasons, four on work-related reasons, six on social and family reasons, and four on miscellaneous reasons. RESULTS: Severe nerve root pain (34%), motor loss (17%), atypical clinical manifestations (13%), severe low back pain (8%), and/or sphincter dysfunction (4%) were recorded in only 55% of patients, and only 16% had at least two of these reasons. A minority of patients were admitted to avoid premature surgery (13%) or to try one more conservative approach prior to surgery (15%). Seventy-five per cent of patients reported at least one of the psychological reasons listed in the questionnaire (irritability/fatigue, 66%; anxiety, 42%; depression, 26%; panic disorder, 21%), 50% reported at least one work-related reason (workaholism, 21%; job offer, 16%; self-employed, 14%; fear of losing their job, 11%), 66% reported at least one social or family reason (living alone, 34%; one or more dependents younger than seven years of age, 32%; too many demands from household members, 22%; one or more dependents older than seven years of age, 8%; need to care for another person, 9%; important upcoming family or personal event, 6%), and 26% reported at least one miscellaneous reason (firm belief that sciatica can be cured only by inhospital treatment, 10%; desire to put pressure on the employer or on an expert, 7% and 6%, respectively; admission via the emergency room without prior medical advice, 6%). CONCLUSION: In France, the reason for admission of patients with disk-related sciatica is frequently a mixture of physical, psychological, and social problems, with only 55% of patients having a symptom requiring inhospital management.

Adult↗

PubMedDate not supplied

[Bilateral cyclic sciatica caused by endometriosis. Apropos of a case].

INTRODUCTION: Cyclical sciatica due to implantation of endometrial tissue in the sciatic nerve in the region of the sciatic notch is a very unusual cause of sciatica. It occurs in women of childbearing age, as episodes of pain in the distribution of the sciatic nerve, which present in a cyclic manner and coincide with menstruation. If it is not treated, a sensomotor mononeuropathy of the sciatic nerve develops. CLINICAL CASE: The patient had complained of right-sided sciatic pain from the age of 36 years. Over the years a motor deficit had slowly and progressively appeared causing foot drop. The painful crises were related to her menstrual periods. At the age of 44 years a pyramidal muscle syndrome was diagnosed and treated surgically. This was followed by increase in the crises of sciatic pain. A year later, she started to have sciatic pain on the left side, which was similar to that of the right side. The clinical, imaging and electrophysiological findings are reported. The patient improved. She is still being treated with depot medroxyprogesterone and her pain has disappeared. CONCLUSIONS: Cyclical sciatica due to endometriosis is little known and may lead to permanent disability. Computerized axial tomography of the pelvis using contrast material is very useful for diagnosis. The use of depot medroxyprogesterone seems to be a satisfactory treatment in some patients.

Endometriosis↗

PubMed2001

[Low back pain and sciatica].

In order to see the patients with low back pain and/or sciatica, it is most important to consider the pathophysiology of symptoms. We should know that the image findings such as X-ray and MRI do not always show the cause of symptom. Because degenerative changes in lumbar spine are common findings in asymptomatic group compared to symptomatic patients with low back pain and sciatica. According to pathophysiology (nerve root syndrome, cauda equina syndrome, facet syndrome, discogenic pain syndrome and intermittent claudication for low back pain), the treatment for low back pain and sciatica were described.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2002

Predicting the outcome of sciatica at short-term follow-up.

BACKGROUND: The prognostic value of the clinical findings elicited in the patient presenting with sciatica is unknown. AIM: To investigate whether history and physical examination findings can predict outcome. DESIGN OF STUDY: Prospective study of prognostic factors. SETTING: A sample of primary care patients with sciatica. METHOD: Short-term favourable outcome was registered as improvement perceived by the patient after two weeks. Long-term failure was defined as eventual surgery or lack of improvement after three months. RESULTS: The signs and symptoms that most consistently predicted an unfavourable outcome were: a disease duration of more than 30 days; increased pain on sitting; and more pain on coughing, sneezing or straining. The straight leg raising test and, to a lesser degree the reversed straight leg raising test, were the most consistent examination findings associated with poor outcome. Chances of short-term improvement were also related to the body weight relative to the length. CONCLUSION: The predictors in this study can indicate the prognosis of patients with sciatica at an early stage. Knowledge of these prognostic factors may help to fine tune treatment decisions and improve patient selection in trials of conservative therapy strategies.

Adult↗

PubMed1975

[The role of surgery in the treatment of sciatica. An experience of more than 4000 operations].

Sciatica must always be first considered as a medical problem. Operation is indicated only for refractory cases. Analysis of more than 4 036 operations shows the best indications for surgery. These consist of typical disc sciatica, sciatica with excessive pain, with paralysis and with cauda equina syndrome. Myeloradiculography was not carried out routinely, being reserved for atypical forms. A negative radiculography is not necessarily a contraindication. The results of foraminotomy are less constant than after removal of a disc prolapse. It benefits 60 p. cent of patients, however. Some reserve applies to its use since it is not possible to predict those patients who will be relieved. There exist finally those cases in which the organic origin of the pain cannot be proved, at which time the surgeon should refuse operation which may be an aggravating factor.

Cauda Equina↗

PubMed2003

Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence.

BACKGROUND: The surgical treatment of sciatica with discectomy is ineffective in a sizable percentage of patients, and reherniation occurs after 5% to 15% of such procedures. The purpose of the present study was to determine if competence of the disc anulus and the type of herniation could be used to predict postoperative clinical outcomes following lumbar discectomy. METHODS: A prospective observational study of 187 consecutive patients undergoing single-level primary lumbar discectomy was conducted. A single surgeon performed all of the procedures, and an independent examiner evaluated 180 of the patients clinically at a minimum of two and a median of six years after surgery. The extent of anular deficiency and the presence of disc fragments were determined. On the basis of these intraoperative findings, disc herniations were classified into four categories: (1) Fragment-Fissure herniations (eighty-nine patients), (2) Fragment-Defect herniations (thirty-three patients), (3) Fragment-Contained herniations (forty-two patients), and (4) No Fragment-Contained herniations (sixteen patients). The effects of disc herniation morphology and preoperative variables on subsequent clinical outcome were determined with the Student t test for continuous variables and chi-square analysis for categorical variables. RESULTS: Patients in the Fragment-Fissure group, who had disc fragments and a small anular defect, had the best overall outcomes and the lowest rates of reherniation (1%) and reoperation (1%). Patients in the Fragment-Contained group had a 10% rate of reherniation and a 5% rate of reoperation. Patients in the Fragment-Defect group, who had extruded fragments and massive posterior anular loss, had a 27% rate of reherniation and a 21% rate of reoperation. Patients in the No Fragment-Contained group did poorly: 38% had recurrent or persistent sciatica, and the standard outcomes scores were less improved compared with those in the other groups (p < 0.001). CONCLUSION: Intraoperative findings, as described in the present study, were more clearly associated with outcomes than were demographic, socioeconomic, or clinical variables. The degree of anular competence after discectomy and the type of herniation appear to have value for the prediction of the recurrence of sciatica, reoperation, and clinical outcome following lumbar discectomy. LEVEL OF EVIDENCE: Prognostic study, Level I-1 (prospective study). See p. 2 for complete description of levels of evidence.

Adult↗

PubMed2004

Predictive value of the duration of sciatica for lumbar discectomy. A prospective cohort study.

The optimum timing of lumbar discectomy for sciatica is imprecise. We have investigated a number of prognostic factors in relation to the outcome of radiculopathy after lumbar discectomy. We recruited 113 consecutive patients of whom 103 (91%) were followed up at one year. We found a significant association between the duration of radiculopathy and the changes in the Oswestry Disability Index score (p = 0.005) and the low back outcome score (p = 0.03). Improvement in pain was independent of all variables. Patients with an uncontained herniated disc had a shorter duration of symptoms and a better functional outcome than those with a contained herniation. Our study suggests that patients with sciatica for more than 12 months have a less favourable outcome. We detected no variation in the results for patients operated on in whom the duration of sciatica was less than 12 months.

Adolescent↗

PubMed1979

[Usefulness of questionnaires in detection of early symptoms of sciatica and related pain syndromes of the lumbosacral region and determination of their incidence among workers of textile industry].

The study was aimed at the determination of sciatica case rate among cotton industry workers based on inquiry. Two questionnaires for detecting complaints typical of sciatica were developed. 2463 weavers and 3083 spinners were examined. A comparative group involved 978 shop attendants and 593 office workers. It was found out that pains characteristic of sciatica were experienced by 45% weavers, 43% shop attendants, 29.2% spinners, and 16% office workers. Results of physical examinations in randomly selected cases corresponded in 97% with the questionnaire data. In most cases pains resulted from overloading of the lower section of the vertebral column.

Back Pain↗

PubMed2005

Interventions that increase or decrease the likelihood of a meaningful improvement in physical health in patients with sciatica.

BACKGROUND AND PURPOSE: The purpose of our study was to determine whether physical therapy interventions predicted meaningful short-term improvement in physical health for patients diagnosed with sciatica. SUBJECTS: We examined data from 1,804 patients (age: mean=52.1 years, SD=15.6 years; 65.7% female, 34.3% male) who had been diagnosed with sciatica and who had completed an episode of outpatient physical therapy. METHODS: Principal components factor analysis was used to define intervention categories from specific treatments applied during the plan of care. A nested-model logistic regression analysis identified intervention categories that predicted meaningful improvement in physical health. Meaningful improvement was defined as a change of 14 or more points on the Physical Component Scale-12 (PCS-12) summary score. RESULTS: Twenty-six percent (n=473) of patients had a meaningful improvement in physical health. Improvement was more likely in patients receiving joint mobility interventions (odds ratio [OR]=2.5, 95% confidence interval [CI]=1.5-4.4) or general exercise (OR=1.5, 95% CI=1.2-2.0). Patients who received spasm reduction interventions were less likely to improve (OR=0.77, 95% CI=0.60-0.98). DISCUSSION AND CONCLUSION: Physical therapists should emphasize the use of joint mobility interventions and exercise when treating patients with sciatica, whereas interventions for spasm reduction should be avoided.

Activities of Daily Living↗

PubMed1989

Sonation of lumbar nerve roots as a diagnostic procedure in patients with sciatica.

It has been suggested that sonation of the lumbar nerve roots in patients with sciatica will precipitate their symptoms and therefore may be a useful diagnostic tool in the evaluation of disc protrusions. Thirty healthy subjects (Group 1), mean age 36 (+/- 6) years, were evaluated to establish a baseline response. None had a positive test. A second group of 35 individuals, mean age 38 (+/- 12) years, all had histories of sciatica and sufficient signs to warrant consideration of a myelogram. Subsequently, all had positive myelograms and positive disc protrusions documented at surgery. Only three of the second group had positive responses to the ultrasound test. The ultrasound was 870 kHz continuous at 2watts/cm2 for two minutes, administered at the lumbar paravertebral muscle mass. The ultrasound test had a high specificity and very low sensitivity (.09), indicating that sonation of the lumbar nerve roots in people with sciatica is not a useful preliminary screening test of low lumbar disc disease.

Adult↗

PubMed1988

Swelling of the cauda equina in patients who have herniation of a lumbar disc. A possible pathogenesis of sciatica.

Morphological changes in the cauda equina in patients who have herniation of a lumbar disc have not been previously reported, to our knowledge. Using computed tomographic myelography, we found swelling of nerve-root elements in the cauda equina that corresponded to the affected root in seventeen of twenty-eight patients who had proved herniation of a lumbar disc. All seventeen patients had severe sciatica. The swelling of the nerve-root elements gradually returned to normal after surgical decompression, which was also associated with improvement of the sciatica. Patients who did not have severe sciatica did not show swollen nerve-root elements. These findings may be an important clue to the mechanism of sciatic pain in patients who have herniation of a lumbar disc.

Adolescent↗

PubMedDate not supplied

Charles Lasègue and his 'Considerations on Sciatica'.

The eponym Lasègue sign has been applied to the increase in sciatic pain caused by flexing the extended lower extremity on the abdomen. The sign was never put into writing by Lasègue but by his pupils. He did not describe the test in the usual reference, "Considerations on Sciatica," in 1864. That article has to do with his analysis of then-current theories of sciatica and his own clinical observations. Sciatica was divided into a benign and a serious form, and two examples of each were described. Emphasis was laid on the constant, fixed sciatic pain, as contrasted with the irregular, largely nocturnal, episodes of lancinating pain. Atrophy of leg muscles was not to be explained on the basis of disuse but by a disorder of the nerve, which also was responsible for the typical neuralgia, unlike that of any other part of the body except possibly neuralgia of the brachial plexus. Treatments currently available (cupping, vesicants, and injections of atropine solution) were unavailing. The steps are unknown by which Lasègue came to modify his 1864 views that any sort of flexion or extension of the lower extremity did not exacerbate the pain; in the 1881 thesis of his pupil, Forst, that straight-leg raising sign is described and illustrated and ascribed to his teacher, Professor Lasègue.

France↗

PubMed1981

Chemonucleolysis for relief of sciatica due to a herniated intervertebral disc.

Chemonucleolysis is the nonoperative chemical removal of displaced lumbar disc material. The enzyme chymopapain, which has a wide margin of safety between its effective therapeutic and toxic doses, is effective in the management of sciatica due to a herniated intervertebral disc. The patient will have leg pain as the dominant symptom and a 50% reduction in straight-leg raising with or without bowstring discomfort and crossover pain. Neurologic symptoms and signs are usual, as are abnormal results of contrast studies, which will verify the level of involvement. In 220 randomly selected patients who met criteria for the diagnosis of sciatica due to a herniated intervertebral disc and did not have psychogenic or nonorganic spinal pain, a spinal stenosis or a history of a previous, unsuccessful operation to relieve the sciatica, chemonucleolysis had a success rate of 80%. The only complications were a severe anaphylactic reaction in two patients and lesser, delayed reactions in five others. All of the reactions were successfully treated. Of the 45 patients in whom chemonucleolysis was unsuccessful, 38 underwent a laminectomy. In 3 of the 38 the results of chemonucleolysis were initially good, but later the disc herniation recurred; thus, the long-term treatment failure rate was 1.4%.

Adult↗

PubMed1995

[Cyclic sciatica and extrauterine endometriosis].

Cyclic sciatica caused by ectopic endometriosis is an unusual cause of compression of a lumbar root, of the sciatic nerve or its plexus. A 38-year-old patient is presented with a history of menstruation associated with right-sided sciatica, which gradually developed over a 2 1/2-year period into disabling constant pain and a lumboradicular syndrome with signs of S1-root involvement. Suggested compression of the sciatic nerve by ectopic endometriosis in the sciatic notch region could be confirmed by CT and MR, by prompt response to hormonal suppression of ovarian function and by regression of the radiological findings. If the history of cyclic pain, local tenderness on deep palpation and the onset of referred pain in the buttock had been observed at the beginning, unnecessary and costly medico-technical procedures delaying diagnosis and treatment (including unnecessary physiotherapy) could have been avoided. Cyclic sciatica is discussed in a review of literature, and possibilities of treatment are discussed.

Adult↗

PubMed1993

[Diagnostic imaging in sciatica. A short historical overview and current status].

Cotugno described the clinical entity of sciatica in 1764. However, the association between sciatica and compression of lumbar nerve roots was not realized until the 1920s. Back surgery for herniated nucleus pulposus then became fashionable, and plain radiography and myelography enabled preoperative mapping. Recently other imaging techniques have emerged, such as computed tomography and magnetic resonance imaging. This has increased the knowledge of the etiology of lumbar root compressions, and invasive therapies for sciatica have become more diversified. It is easy to lose perspective among the available imaging procedures and therapeutic techniques. The aim of this paper is to present the current status from a historical point of view, with special emphasis on the most common imaging methods for the investigation of lumbosacral radiculopathies.

Diagnostic Imaging↗