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PubMed1995

Long-term follow up of 57 patients undergoing automated percutaneous discectomy.

Automated percutaneous discectomy has been performed in 57 patients at the author's institution since 1989, representing 4% of all lumbar spine surgeries. All 57 patients had unilateral sciatica. There were 33 women and 24 men ranging from 24 to 49 years of age, with a mean age of 45 years. All patients underwent computerized tomography (CT) in the prone position and CT and magnetic resonance imaging in the supine position. Diffuse versus eccentric disc bulging was determined for each patient. Four patients underwent surgery at the L3-4 level, four at L5-S1, and 49 at L4-5. One L5-S1 case could not be cannulated and surgery was aborted. There have been no complications related to surgery. Fifty patients (88%) stated they had reduced sciatica in the first 2 postoperative weeks. Forty (70%) had reduced sciatica 2 months postoperatively. The mean follow-up period was 27 months (range 6 to 45 months), with no patient lost to follow up. At their last follow-up examination, 33 patients (58%) showed improvement in their sciatica but only three (5%) were completely pain free. Of the 17 recurrences of sciatica, 11 patients have undergone microdiscectomy, with eight showing improvement. Chi-square analysis demonstrated a significantly better chance of improvement in patients with discs bulging eccentrically to the side of sciatica (p < 0.05) compared to patients with diffusely bulging discs. Automated percutaneous discectomy is safe and in selected patients can reduce sciatica, but only completely eliminated sciatica in 5% of patients with a follow-up period of 2.5 years.

Adult↗
PubMed1992

[Causes and mechanisms of sciatic pains].

Pain along the sciatic nerve can be due to many causes. Sciatica of radicular origin caused by compression of L5 or S1 root is usually separated from truncular or peripheral sciatica. Radicular sciatica is divided into mechanical sciatica and the so-called inflammatory sciatica. In the majority of cases radicular pain is of mechanical origin and due to discal herniation in L4-L5 or L5-S1. The herniation can be visualized by lumbar computerized tomography or by radiculography. However, discal herniation alone does not fully account for the pain suffered, and inflammatory processes around the disc and the nerve root play an important role. Posterior intervertebral osteoarthritis and lumbar canal stenosis also are frequent causes of sciatic pain. Truncular sciatica is much less frequent and should incite clinicians to investigate for pelvic tumoral infiltration. Peripheral sciatica is usually caused by suffering of the external popliteal nerve around the neck of the fibula, but it may also be caused by compression of a ramus from the internal popliteal nerve, resulting in tarsal tunnel syndrome or in Morton's syndrome.

Humans↗
PubMed1997

Phospholipase A2 activity in herniated lumbar discs. Clinical correlations and inhibition by piroxicam.

STUDY DESIGN: Prospective study of phospholipase A2 activity in the serum and intervertebral discs of patients undergoing surgery for sciatica due to disc herniation. OBJECTIVES: To determine correlations between herniated disc phospholipase A2 and clinical, radiographic, and anatomic signs of common sciatica; to evaluate serum phospholipase A2 activity as a marker of disc phospholipase A2; and to investigate the in vivo effect of piroxicam on disc phospholipase A2. SUMMARY OF BACKGROUND DATA: Several studies suggest disc inflammation as a mechanism of sciatica due to disc herniation, and phospholipase A2 emerges as a key enzyme of cartilage and disc tissues. METHODS: Phospholipase A2 activity was determined, using the degradation of a specific substrate, in the serum and discs of 31 patients (14 treated with acetaminophen and 17 treated with piroxicam) undergoing surgery for sciatica due to lumbar disc herniation. Visual analog scale for pain, Dallas Pain Questionnaire, Lasègue's sign, radiographic stage of degeneration of the herniated disc, volume of disc herniation shown by computed tomography, and surgical findings were recorded. RESULTS: Disc phospholipase A2 activity was independent of the patient's age or sex, the radiologic stage of disc degeneration, and the volume of the herniation, and showed no significant correlation with Lasègue's sign or pain measured on a visual analog scale. The correlation between disc phospholipase A2 and the Dallas category of items measuring the impact of pain on daily activities approached the level of significance (P = 0.07). Disc phospholipase A2 activity was significantly higher in cases of sequestrated discs than in other herniations. Disc phospholipase A2 was significantly correlated with serum phospholipase A2, and was significantly lower in patients treated with piroxicam than in those treated with acetaminophen. CONCLUSIONS: Disc phospholipase A2 is thought to participate in the physiopathology of sciatica and to bemodulated by nonsteroidal anti-inflammatory drug therapy. Serum phospholipase A2 is suggested as a biologic marker of disc inflammation in patients with sciatica.

Acetaminophen↗
PubMed1992

Lumbar disk disease: epidemiology.

Sciatica is a common symptom that affects as many as 40% of the adult population at some time. However, clinically significant sciatica is much less common and occurs in only 4% to 6% of the population. Exactly how often the symptom is caused by lumbar disk herniation is uncertain; it is known that herniation can occur independent of symptoms. Among the factors associated with its occurrence are age, gender, occupation, cigarette smoking, and exposure to vehicular vibration. The contribution of other factors such as height, weight, and genetics is less certain. The majority of patients with sciatica appear to recover. Approximately 20% of patients with sciatica caused by lumbar herniation have a strong indication for surgical intervention. In the remainder, indications are based primarily on pain rather than functionally significant neurologic deficits. Because pain is the principle indication, there are wide variations in the rates of surgical intervention between countries, and, even within countries, there are significant regional variations. These variations appear to be driven less by specific medical factors and more by gender, occupation, income, education, and the surgeon's preference. Although the contribution of sciatica to low back pain disability remains uncertain, disability caused by low back pain and sciatica appears to be increasing at a rate disproportionate to population growth. To what degree surgery now contributes to that disability is uncertain, but limited information suggests that it may be substantial.

Adult↗
PubMed2005

Isokinetic muscle strength of the trunk and bilateral knees in young subjects with lumbar disc herniation.

STUDY DESIGN: Cross-sectional study comparing normal subjects and patients with lumbar disc herniation. OBJECTIVE: To evaluate trunk and knee muscle strength in patients with L4-L5 and/or L5-S1 disc herniation. SUMMARY OF BACKGROUND DATA: Numerous studies have shown that patients with low back pain have weaker trunk muscles. The strength of trunk and knee muscles has not been investigated simultaneously in patients with lumbar disc herniation. METHODS: Forty-one controls and 2 patients were included. Isokinetic strength of the trunk and bilateral knees was tested on a calibrated isokinetic testing machine (Biodex System 3 Pro) regardless of the laterality of the radiculopathy. The testing was carrying out at two different velocities: 60 degrees and 120 degrees per second. RESULTS: Total trunk strength and knee strength were significantly lower in these patients (4.34 +/- 1.06 and 4.06 +/- 1.16 vs. 6.21 +/- 1.05 and 5.83 +/- 1.09 Nm/kg at 60 degrees and 120 degrees per second, respectively, P < 0.001). In patients with unilateral sciatica, there was no significant difference (P > 0.05) in unilateral knee strength between sciatica-involved and -uninvolved limbs (1.89 +/- 0.5, 1.08 +/- 0.45, 1.48 +/- 0.58, 0.93 +/- 0.41 vs. 1.68 +/- 0.45, 0.91 +/- 0.38, 1.41 +/- 0.48, 0.79 +/- 0.39 Nm/kg in sciatica-uninvolved vs. sciatica-involved limbs during extension and flexion at 60 degrees and 120 degrees per second, respectively). Total trunk strength was significantly correlated with total knee strength in both groups. CONCLUSIONS: In the patients with lumbar disc herniation, muscle strength of the trunk and knees was decreased to a similar extent. Weaker knee strength was found on either side of the lower extremity in the patients with unilateral sciatica, regardless of its location.

Adult↗
PubMedDate not supplied

[Non discal surgical sciatic neuralgia (author's transl)].

Non discal sciatic neuralgia accounts for 5 per cent of all cases of surgical sciatica. They are divided into four groups: central sciatica very seldom, cordal and root sciatica more common and truncal sciatica. These sciatica are dominated by atypical clinical features: atypical provoking factor, atypical character, atypical topography and therapy. A good x-rays study is necessary involving myelography, angiography of the spine etc., but discography and lumbar phlebography are not useful. A rapid review of aetiologies shows that they cover a wide area and that therapy must be debated for each case.

Diagnosis, Differential↗
PubMed1983

[Painful sciatic rubbing caused by benign synovioma of the spinal joints. Apropos of 4 cases].

Synovioma, a benign neoplasm arising from pigmented villonodular synovium or synovitis, is uncommon. It involves the tendons and joints of the finger, ankle and foot. In this study four cases of villonodular synovioma of spinal joints are reported. The authors studied 555 cases of patients operated for sciatica due to herniated disk. Histopathology showed that in four out of 555 cases sciatica was found to be due to synoviomas of the spinal joints. The patients, three women and one man, were between 54 and 70 years of age and each had had a long history of low back pain with episodes of sciatica. Clinical evaluation at the time of surgery showed moderate severity of signs and symptoms. Roentgenographic studies of all four cases revealed osteoarthritic changes of vertebral apophyses, with two cases of spondylolisthesis. The pathogenesis of synovioma remains controversial and its histopathological characterization -hyperplasia VS/true tumours- has not yet been determined. It is possible that the number of recorded cases of sciatica due to synoviomas is small because surgical and pathological studies in patients with sciatica associated with osteoarthritic changes have not been adequately performed. Surgery consists of a large resection of the capsule and ligament including resection of intraspinal extension. Because this study involves only four cases, the first of which occurred in 1977, the possibility of recurrence cannot be evaluated.

Aged↗
PubMed1998

Gadolinium-DTPA enhancement of symptomatic nerve roots in MRI of the lumbar spine.

Disc prolapse presenting with sciatica may be associated with enhancement of the symptomatic nerve root following magnetic resonance imaging (MRI) with intravenous gadolinium (Gd)-DTPA. Previous studies have shown, however, that this does not occur in all cases. The aim of this study was to assess the incidence of nerve root enhancement in patients with sciatica and disc prolapse and to try to identify any specific features that might be associated with the phenomenon. A total of 227 patients presenting with low back pain and/or sciatica underwent a MRI study of the lumbar spine with intravenous contrast enhancement. Nineteen of 81 (23.5 %) patients with disc prolapse demonstrated nerve root enhancement. Nerve root enhancement had a highly significant association with sequestrated disc lesions (13/19, 68 %; P < 0.0005), and was primarily seen in the symptomatic ipsilateral nerve root (16/19, 84 %). The sensitivity of nerve root enhancement associated with disc prolapse was 23.5 % with a specificity of 95.9 %, a positive predictive value of 76 % and a negative predictive value of 69.3 %. Nerve root enhancement may be indicative of the symptomatic level but its poor sensitivity negates the routine use of Gd-DTPA in MRI for sciatica.

Contrast Media↗
PubMed2006

Association between sitting and occupational LBP.

Low back pain (LBP) has been identified as one of the most costly disorders among the worldwide working population. Sitting has been associated with risk of developing LBP. The purpose of this literature review is to assemble and describe evidence of research on the association between sitting and the presence of LBP. The systematic literature review was restricted to those occupations that require sitting for more than half of working time and where workers have physical co-exposure factors such as whole body vibration (WBV) and/or awkward postures. Twenty-five studies were carefully selected and critically reviewed, and a model was developed to describe the relationships between these factors. Sitting alone was not associated with the risk of developing LBP. However, when the co-exposure factors of WBV and awkward postures were added to the analysis, the risk of LBP increased fourfold. The occupational group that showed the strongest association with LBP was Helicopter Pilots (OR=9.0, 90% CI 4.9-16.4). For all studied occupations, the odds ratio (OR) increased when WBV and/or awkward postures were analyzed as co-exposure factors. WBV while sitting was also independently associated with non-specific LBP and sciatica. Vibration dose, as well as vibration magnitude and duration of exposure, were associated with LBP in all occupations. Exposure duration was associated with LBP to a greater extent than vibration magnitude. However, for the presence of sciatica, this difference was not found. Awkward posture was also independently associated with the presence of LBP and/or sciatica. The risk effect of prolonged sitting increased significantly when the factors of WBV and awkward postures were combined. Sitting by itself does not increase the risk of LBP. However, sitting for more than half a workday, in combination with WBV and/or awkward postures, does increase the likelihood of having LBP and/or sciatica, and it is the combination of those risk factors, which leads to the greatest increase in LBP.

Biomechanical Phenomena↗
PubMed1995

Characterization of thermal hyperalgesia, c-fos expression, and alterations in neuropeptides after mechanical irritation of the dorsal root ganglion.

STUDY DESIGN: This study analyzed hypersensitization in sensory systems after mechanical irritation of the dorsal root ganglion. OBJECTIVES: To develop a reliable and reproducible animal model of hyperalgesia arising from the dorsal root ganglion and to understand the unique contributions of the dorsal root ganglion to clinical manifestations of sciatica. SUMMARY OF BACKGROUND DATA: The dorsal root ganglion likely plays an important role in disorders of sciatica. However, no previous study has analyzed sciatica after irritation of the dorsal root ganglion. Thermal hyperalgesia indicates a decrease in thermal nociceptive threshold and hypersensitization in sensory systems. METHODS: The left L4 and L5 dorsal root ganglia in rats (n = 22) were exposed circumferentially. Other rats (n = 22) also had the left L4 and L5 dorsal root ganglia ligated loosely with two 4-0 chromic gut sutures. Changes in thermal withdrawal latency were examined in the hindpaws across time. Substance P and vasoactive intestinal polypeptide contents were quantified in the dorsal root ganglion and spinal cord. Substance P, calcitonin gene-related peptide, and c-fos expression also were examined in the spinal cord by immunohistochemistry. In addition, histologic changes in myelinated nerve content were examined in the dorsal root ganglion. RESULTS: Thermal hyperalgesia occurred in rats with exposure of the dorsal root ganglion and in rats with loose ligation of the dorsal root ganglion, and was accompanied by an increase in c-fos expression and spontaneous pain-related behaviors. CONCLUSIONS: This experimental model reliably produced a disorder resembling an acute phase sciatica and should help further advance the understanding of pathomechanisms of spinal pain after irritation of the dorsal root ganglion in humans.

Animals↗
PubMed2001

Disc herniation-related back pain impairs feed-forward control of paraspinal muscles.

STUDY DESIGN: A comparative study of lumbar paraspinal muscle reflexes during sudden upper limb loading in healthy control subjects and patients with sciatica. OBJECTIVES: To assess reflex activation of paraspinal muscles during sudden upper limb loading. SUMMARY OF BACKGROUND DATA: Sudden upper limb loading and upper limb voluntary movements cause reflex activation of trunk muscles. A short latency response of approximately 50 msec of lumbar muscles has been observed before, but the reflexes have not been studied in patients with sciatica. METHODS: The paraspinal muscle responses for upper limb loading during unexpected and expected conditions were measured by surface EMG from 20 patients selected for an operation as a result of disc herniation-related chronic low back pain and 15 back-healthy controls. Pain, disability, and depression scores were recorded. RESULTS: Short latency response of paraspinal muscles for unexpected upper limb loading was similar in healthy controls and patients with sciatica in supported standing. During normal standing anticipation shortened the lumbar reflex latency in healthy controls but not among the patients. CONCLUSIONS: The results provide evidence for impaired feed-forward control of lumbar muscles in patients with sciatica.

Adult↗
PubMed2001

The diagnostic effect from axial loading of the lumbar spine during computed tomography and magnetic resonance imaging in patients with degenerative disorders.

STUDY DESIGN: Patients with low back pain, sciatica, and neurogenic claudication were observed during computed tomographic myelography or magnetic resonance imaging in psoas-relaxed position and axially compressed supine position of the lumbar spine. OBJECTIVE: To estimate the clinical value of axially loaded imaging in patients with degenerative disorders of the lumbar spine. SUMMARY OF BACKGROUND DATA: Computed tomography and magnetic resonance imaging still are performed with the lumbar spine in a supine relaxed position, which results in unloading of the spine and enlargement of the canal. METHODS: A device for axial loading of the lumbar spine in computed tomography and magnetic resonance imaging was used. Altogether, 172 patients were examined in psoas-relaxed position and axially compressed supine position of the lumbar spine: 50 patients with computed tomographic myelography and 122 patients with magnetic resonance imaging. If a significant decrease (>15 mm2) in the dural sac cross-sectional area to values smaller than 75 mm2 (the borderline value for stenosis) was found during examination in axial loading, or if a suspected disc herniation, narrow lateral recess, narrow intervertebral foramen, or intraspinal synovial cyst changed to being obvious at the axial loading examination, this was regarded as additional information important for the treatment. RESULTS: Additional valuable information was found in 50 of 172 patients (29%) during examination in axial loading. In the different diagnostic groups, additional valuable information was found in 69% of the patients with neurogenic claudication, in 14% of the patients with sciatica, and in 0% of the patients with low back pain. The percentage of additional valuable information increased to 50% in the patients with sciatica, if recommended inclusion criteria for examinations in axial loading were used. A narrowing of the lateral recess causing compression of the nerve root was found at 42 levels in 35 patients at axial loading. CONCLUSION: According to the study results, axially loaded imaging adds frequent additional valuable information, as compared with conventional imaging methods, especially in patients with neurogenic claudication, but also in patients with sciatica if defined inclusion criteria are used.

Adult↗