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PubMed1995

CT-diskography in patients with sciatica. Comparison with plain CT and MR imaging.

AIMS: The findings at CT-diskography (CT-D), including recording of the pain introduced at contrast injection, were compared with plain CT and MR imaging in 111 disks in 101 patients aged 18 to 68 years. RESULTS: Six disks which were normal at CT had normal CT-D and 5 of them had normal signal on MR imaging. The degree of annular degeneration and the depth of the annular tears were significantly associated with each other and with loss of disk height, but not with size or location of the hernias. Only the depth of the tears was significantly associated with loss of signal on MR. However, frequently complete annular tears and severe annular degeneration were seen in association with small bulges and hernias, even in disks with normal or slightly reduced signal on MR and with normal height. The type and intensity of the pain introduced were associated with each other and with the depth of the annular tears, but not with the degree of annular degeneration, size of the hernia or the MR signal intensity of the disks. CONCLUSIONS: Annular degeneration and tears on one hand, and the type and intensity of pain introduced on the other, seem to be related than separate phenomena.

Adolescent↗
PubMedDate not supplied

The tendon reflexes in the electrodiagnosis of sciatica.

In order to determine the diagnostic value of the electromyographically tested tendon reflexes (ETR) in lumbosacral radiculopathies, we compared the latency and amplitude of the knee (EKTR) and Achilles tendon reflex (EATR) to their clinical testing and to the EMG and H reflex values in 200 non selected patients (126 men, 74 women) aged 24-68 years (48.6 +/- 9.4). The control group was composed of 50 healthy volunteers (28 men, 22 women) aged 25-60 yrs (44 +/- 8.5). The combined electrophysiological reflex examination was abnormal in 45% of the affected limbs, being the most frequent pathological finding. EMG was abnormal in 34.4% and H reflex in 30.4% of the affected limbs. Furthermore, the EATR taken separately was more sensitive than the H-reflex (42.8% versus 30.4%). Pathological ETR were elicited in a considerable percentage of the clinically normal tendon reflexes (TR): 7.3% of the knee and 14.1% of the Achilles TR. On the other hand 65% of the clinically absent ATR were recorded electrically producing abnormally low and delayed muscle evoked potentials.

Adult↗
PubMedDate not supplied

[Rhabdomyolysis and truncular sciatica. 2 cases studied by MRI].

We report two cases of acute rhabdomyolysis in pelvic girdle muscles with sciatic palsy secondary to compression of the sciatic nerve trunk, with clinical and MRI correlation. The diagnosis of rhabdomyolysis is based on clinical and biological data, but diagnosis of compression complications secondary to swelling of the muscles, especially the compression of nerve trunk, is done by imaging. T2 weighted images give a definite anatomical evaluation. They show enlarged high signal intensity muscles and anatomic relationship with the sciatic nerve from its emergence out of pelvis, giving a good correlation between rhabdomyolysis and the compressed nervous trunk. It helps for planning a possible surgical fasciotomy. However, MRI provides only morphological informations, but not differentiates edema from necrosis in involved muscles.

Acute Disease↗
PubMedDate not supplied

Lower back pain and sciatica: how best to manage them.

In this age of easy access to non-invasive computed tomography and magnetic resonance imaging, the clinician is faced with the dilemma of whether or not to remove the patient's intervertebral disc herniation in order to relieve the pain caused by lumbosacral nerve root compromise. This review outlines the rationale for instituting a series of epidural injection techniques, before resorting to surgery.

Bed Rest↗
PubMed1995

[Pseudo-sciatica of neoplastic origin: apropos of an unusual case].

The authors report a case of 'pseudosciatic' pain due to bone metastasis located in the sacroiliac joint secondary to breast cancer. Complementary investigations are mandatory in any case of sciatic pain starting at 80 years of age, even in the absence of the usual criteria suggesting a neoplastic origin. In this case our investigations revealed sacroiliac bone metastasis from the breast, explaining the clinical picture. Primary and secondary sacral tumors are uncommon. Their clinical manifestations are unspecific, consisting mainly of low back pain and sciatic pain. CT scan and MRI are the best tools to evaluate these lesions. Conservative management, combining radiotherapy and hormonal treatment, has been effective in terms of both pain and function.

Aged↗
PubMed1976

[Sciatica and occult sacral meningocele].

The authors present the case of a 43-years-old man who had suffered from back pain for 7 to 8 years followed by sciatic. X-rays showed an abnormal sacral cavity extending from S1 to S3. Wtih the suspicion of an occult sacral meningocoele, Dimer X radiculography showed a cystic formation at S2 which only partially filled the sacral cavity. There was also an L5-S1 disc protrusion. At operation, after exploration of the roots on both sides, it was possible to remove a disc herniation at L5-S1 on the right. Laminectomy of S1 and opening of the posterior wall of the sacral canal at S2 and S3 revealed a large cyst of epidural location, touching both S1 roots superiorly and situated behind the communicating cystic cavity seen at radiculography. Histological examination of the sacral cyst showed it to be a dura mater structure, in fact anon-communicating meningocoele.

Adult↗