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PubMed1997

[Epidural glucocorticoid injection in lumbago sciatica].

Within the past decades, epidural steroid injections have been used in the treatment of severe low back pain and sciatica. In reviewing papers for this article an effort is made to concentrate on those that meet commonly accepted research design criteria, such as being blinded, randomized and prospective. The risks and the advantages of the procedure are discussed. Some of the studies report an efficient reduction in low back pain and sciatica for a longer period. Risks of more serious complications are low using the right technique. However, the results are to some extent conflicting. Future correctly designed studies are necessary to clarify whether the injection should be a supplement to the established treatment of low back pain and sciatica.

Glucocorticoids↗

PubMed2006

[Hip paraosteoarthropathy after sciatica nerve injury by quinine intramuscular injection].

INTRODUCTION: Often occurring in central nerve injuries, paraosteoarthropathic conditions are revealed by a stiffness or ankylosis of the joint. Their occurring during peripheral nerve injuries is rare. OBJECTIVE: To report a case of hip paraosteoarthropathy features after sciatica nerve injury by quinine intramuscular injection. MATERIALS AND METHOD: We report a case of a 24-year-old patient presenting with pain, oedema of the left buttock, limitation of bending of the left hip, and antalgic limping associated with a small step because of axonal left sciatic nerve injury. Initial pelvis X-ray and laboratory findings were normal. Reviewed 4 months later with important stiffness of the left hip, a second X-ray showed an atypical paraosteoarthropathy (POA). Chemotherapy and physiotherapy alleviated neurological muscle weakness but did not have any effect on the hip functionality. Surgical excision was the only treatment that improved the amplitude of movements. Evolution 7 years later showed the disappearance of the peripheral nerve-injury signs and the conservation of the movement amplitude obtained after excision, without a return to normal. CONCLUSION-DISCUSSION: Factors pointing to this POA were initial oedema, immobilization because of pain, and trauma by quinine intramuscular injection. The interest is the exceptional occurrence of POA on a peripheral nerve injury (sciatica nerve injury by quinine injection) outside the context of length resuscitation and that sciatica nerve injury is frequent in tropical countries but anachronistic in a developed one.

Adult↗

PubMed2000

Epidural steroid injection for sciatica: An analysis of 526 consecutive cases with measurements and the whistle test.

The effects of epidural injections of triamcinolone acetonide and bupivacaine in the treatment of sciatica were analyzed in a retrospective series of 526 consecutive cases with measurements. A new test (the whistle test) is described. There is a paucity of measureable parameters in reports on the subject in the literature, and many are not specific or symptom-oriented to sciatica. The procedure was performed by the same operator and reviewed one week post-operatively with measurements. 491 patients (93.35%) achieved excellent to good pain relief, backed by appropriate increases of straight-leg-raise measurements. But 17 patients (3.46%) of this group required surgery later. It is concluded that epidural steroid injection is a simple, cost-effective and minimally invasive treatment for sciatica, especially in the acute. It also serves as a method for crisis intervention and as a prognosticator.

Journal Article↗

PubMed1998

Problem in diagnostic imaging: a patient with sciatica.

This article presents the imaging findings in a patient with sciatica. The reader is invited to identify the labeled anatomical structures and the lesions present. The discussion focuses on the anatomy of the lumbar spine and the relative merits of the various methods of imaging a patient with sciatica.

Adult↗

PubMed2000

Bed rest for acute low back pain and sciatica.

BACKGROUND: Low back pain is a common reason for consulting a general practitioner, and advice on daily activities constitutes an important part in the primary care management of low back pain. OBJECTIVES: To assess the effects of bed rest for patients with acute low back pain or sciatica. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Group trial register, Cochrane Controlled Trials Register, MEDLINE, Embase, Sport, Scisearch, and reference lists of relevant articles. We also contacted authors of relevant articles. Date of the most recent searches: December 1998. SELECTION CRITERIA: We included all randomised studies or quasi randomised studies where at least one comparison group of adult patients with acute low back pain with or without radiation of pain below the knee was advised to rest in bed for at least two days and one group was not, or where comparison groups were advised to stay in bed for different lengths of time. The main outcomes of interest were pain, functional status, recovery and return to work. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion, assessed the validity of included trials and extracted data. Investigators were contacted to obtain missing information. MAIN RESULTS: Nine trials with a total of 1435 patients were included. Five trials met all four validity criteria and were assessed to have low risk of bias, while four trials were assessed to have moderate to high risk of bias. Four trials compared bed rest with advice to stay active, and overall the results were heterogeneous. Overall results from two high quality studies indicate no difference in pain intensity at three weeks follow-up [Standardized Mean Difference 0.0 (95%CI: -0.3, 0.2)], and a small difference in functional status in favour of staying active [Weighted Mean Difference 3.2 (on a 0-100 scale) (95%CI 0.6, 5.8)]. Two high quality trials reported no differences in pain intensity between two to three days of bed rest and seven days of bed rest. Another two high-quality trials found no differences between bed rest and exercises in pain intensity or functional status. REVIEWER'S CONCLUSIONS: Bed rest compared to acvice to stay active will at best have small effects, and at worst might have small harmful effects on acute LBP. Differences in effects of advice to stay in bed compared with advice to stay active are small for patients with low back pain with or without sciatica. There is not an important difference in the effects of bed rest compared with exercises in the treatment of acute low back pain, or seven days compared with two to three days of bed rest in patients with low back pain of different duration with and without radiating pain.

Acute Disease↗

PubMed1979

Relative efficacy of clinical examination, electromyography, plain film radiography, myelography and lumbar phlebography in the diagnosis of low back pain and sciatica.

The procedures used in the investigation of low back pain and sciatica have been subjected to a double statistical analysis to determine their diagnostic accuracy, since contradictory opinions have been expressed in the literature. It was found that only lumbar phlebography was more accurate than the most simple procedure, the clinical examination. Myelography is more accurate than clinical examination only in making a positive diagnosis. In this case, it equals the reliability of lumbar phlebography, but so does plain film radiography which however leads to a positive diagnosis less constantly. Lumbar phlebography is the most accurate procedure for making a negative diagnosis, mainly by avoiding a false negative conclusion. A comparison is made with the statements in the literature and the complementary use of the different procedures is proposed for the investigation of low back pain and sciatica.

Adolescent↗

PubMed1985

Long-term results of autotraction in the treatment of lumbago and sciatica. An attempt to correlate clinical results with objective parameters.

In a prospective study, 49 patients with sciatica radiating below the knee and with a duration of symptoms with no improvement for 6 weeks or more were treated with autotraction and followed up for 1 year. The patients were examined before and after treatment with thermography, and in addition to a clinical examination, they had to complete a form giving the history of their illness and an assessment of ADL. Seventy-nine percent of the patients conditions were good or improved after autotraction. These results were in accordance with the thermography and ADL score used as objective parameters. We therefore believe that the autotraction method of Gerturd Lind has a place in the treatment of chronic lumbago and sciatica.

Back Pain↗

PubMed1985

Thermography in low back pain and sciatica.

This investigation proved that thermography is a reliable method of examination. When the difference of temperature in the legs reached 1 degree C or more, there was a correlation between clinical sciatica and the thermographic registration in 51 of 52 patients. As regards diagnosing the level, thermography is unreliable for distinguishing an L4/L5 syndrome from an S1 syndrome. In this investigation it was possible to correlate colder zones and the clinical syndrome in most patients. However, there is a large overlap between the dermatomes. When following up the results of autotraction no certain conclusions can be drawn, but among the patients with sciatica the decrease in temperature was greater in the group who clinically recovered.

Adolescent↗

PubMed1984

Predictive value of clinical and surgical findings in patients with lumbago-sciatica. A prospective study (Part I).

In a prospective, consecutive study of patients with lumbar back pain and sciatica, various clinical features and surgical findings were evaluated in order to analyse the predictive value regarding (1) level of diseased interspace (2) presence and type of lesion responsible for root compression (3) outcome after surgery. One hundred patients underwent surgery solely on clinical grounds. Fifty-eight had disc herniation. The level of disc herniation was correctly predicted in three quarters of patients with a prolapsed disc. The outcome after surgery was good in 77 patients. Only few clinical features, namely male sex and scoliosis were predictors of a good outcome. Lasegue's sign was indicative of root compression in 90%, but only two-thirds had disc herniation. Conversely one-third had disc herniation in spite of a "negative" test. Lasegue's sign was not superior to other clinical tests in predicting outcome. The most important indicator of a good outcome was the presence of disc herniation at surgery. Patients with disc pathology other than true disc herniation fared equally with patients, who had normal discs disclosed at surgery. Myelography was undertaken in all patients prior to surgery, the results of which are analysed in the following paper. (Espersen et al.: Predictive value of radiculography in patients with lumbago-sciatica. A prospective study (Part II, Acta Neurochirurgica 73 (1984), 213-221.

Back Pain↗

PubMed1986

Sciatica--management by chemonucleolysis versus surgical discectomy.

Two therapeutic approaches designed specifically to relieve the symptoms of sciatica and resolve the signs of lumbar radiculopathy brought about by herniation of the nucleus pulposus have evolved. The surgical removal of the lumbar disc is an operation which has undergone miniaturization in recent years. Treatment of disc hernia by chemical hydrolysis of the nucleus pulposus (chemonucleolysis) has, over the past 20 years, become an alternative to open surgical treatment. These two forms of therapy are compared as to their efficacy and safety. Neurosurgeons now have the data to decide on the suitability of employing one or the other (or both) of these forms of treatment in the care of patients with intractable sciatica.

Chymopapain↗

PubMed1994

Elevated cerebrospinal fluid proteins in sciatica caused by disc herniation.

We carried out a study of cerebrospinal fluid (CSF) proteins in 180 patients with sciatica caused by lumbar disc herniation to elucidate further the degree and mechanisms of protein elevations. The 63 controls were patients with tension headache or migraine without aura. The CSF/serum albumin ratios were higher in the patients (mean 8.84, SD 5.16) than in the controls (mean 5.60, SD 2.33). Similar differences were found for the CSF/serum IgG ratios and the CSF-total proteins. The CSF/serum albumin ratios, CSF/serum IgG ratios and the CSF-total protein concentrations were higher in men than in women among the patients. We suggest that the significant difference in ratio parameters between patients and controls indicates a leak of plasma albumin, most likely IgG, into the CSF in patients with sciatica. The leak was more pronounced in men. Also in the control group the CSF/serum albumin and CSF/serum IgG ratios were higher in men.

Adolescent↗

PubMed1994

Morbus de Anquin or spinous engagement syndrome. A rare cause of low-back pain syndrome and sciatica.

We report on a rare disease called to Anquin's disease or spinous engagement or impingement syndrome. Low-back pain in this specific syndrome probably combined with sciatica is caused by a hypertrophic spinous process along with a spina bifida occulta of the underlying vertebra. Mostly, the enlarged spinous process is seen at L5 and the spina bifida occulta at S1. Conservative therapy consists of physiotherapy with postural exercises including improvement of lumbar flexion. If conservative treatment is unsuccessful, surgical treatment is indicated. Surgical therapy should include resection of the hypertrophic spinous process, probably combined with revision of the nerve roots and division of adhesions. Between 1981 and 1993 six patients were treated surgically after long-lasting periods of conservative therapy. All patients were re-examined clinically and radiologically after a mean follow-up period of 2.9 years. In all but one patient a distinct release from lumbar back pain and/or sciatica was observed. Regarding this, the most important fact in de Anquin's disease is to be aware of this specific syndrome. If low-back pain can be traced to a hypertrophic spinous process the first choice of therapy should be conservative. In unsuccessful cases simple surgical resection probably combined with division of the adhesion can lead to significant release from pain and is recommended.

Adult↗

PubMed1999

Sciatica caused by a dilated epidural vein: MR findings.

We report the MR imaging findings in a 41-year-old woman presenting with sudden low back pain and sciatica. At surgery a dilated epidural vein was found compressing the nerve root. The MR findings may suggest the diagnosis. Magnetic resonance imaging of a dilated epidural vein or varix causing sciatica has not been reported until now.

Adult↗

PubMed2006

Epidural neuroplasty versus physiotherapy to relieve pain in patients with sciatica: a prospective randomized blinded clinical trial.

BACKGROUND: Epidural neuroplasty seems to be one of the promising minimally invasive techniques for adhesiolysis in patients with chronic sciatica with or without low back pain. However, because no data exist from randomized studies the aim was to investigate whether this procedure is superior to conservative treatment with physiotherapy. METHODS: A total of 99 patients with chronic low back pain were enrolled in this study and randomly assigned into either a group with physiotherapy (n = 52) or a second group undergoing epidural neuroplasty (n = 47). Patients were assessed before and 3, 6, and 12 months after treatment by a blinded investigator. RESULTS: After 3 months, the visual analog scale (VAS) score for back and leg pain was significantly reduced in the epidural neuroplasty group, and the need for pain medication was reduced in both groups. Furthermore, the VAS for back and leg pain as well as the Oswestry disability score were significantly reduced until 12 months after the procedure in contrast to the group that received conservative treatment. CONCLUSIONS: Epidural neuroplasty results in significant alleviation of pain and functional disability in patients with chronic low back pain and sciatica based on disc protrusion/prolapse or failed back surgery on a short-term basis as well as at 12 months of follow-up.

Adult↗

PubMed2002

Sacral magnetic stimulation for pain relief from pudendal neuralgia and sciatica.

INTRODUCTION: Magnetic stimulation of the sacral nerve roots is used for neurologic examination. However, no one has reported therapeutic efficacy of pain relief from pudendal neuralgia with sacral magnetic stimulation. METHODS: Five patients with pudendal neuralgia or sciatica received 30 to 50 pulsed magnetic stimuli of the sacral nerve roots. The median age of the patients was 59 (range, 28-69) years; there were 3 females. RESULTS: Sacral magnetic stimulation immediately eliminated the pain. The pain relief lasted between 30 minutes and 56 days (median, 24 hours). Adverse effects were not observed. CONCLUSIONS: This pilot study indicates that magnetic stimulation of the sacral nerve roots may be a promising therapeutic modality for pain relief from pudendal neuralgia and sciatica. Further studies should be performed to determine the appropriate intensity and frequency, as well as the utility of a second course, of magnetic stimulation treatment.

Female↗

PubMedDate not supplied

Comparison of the onset and intensity of action of intramuscular meloxicam and oral meloxicam in patients with acute sciatica.

In this randomized, double-blind, double-dummy trial, 113 patients with acute sciatica were treated with a single 15-mg dose of meloxicam given intramuscularly (n = 54) or orally (n = 59). There was a significant improvement in induced pain (as measured by using the straight-leg-raising test) in both treatment groups at 60 minutes (P < 0.005), and there was a significant difference in favor of the intramuscular formulation in terms of the time to maximum improvement of induced pain (P = 0.01). Changes in spontaneous pain were similar in both treatment groups and were significant versus baseline (P < 0.01) at 30 minutes after study drug administration. Global efficacy evaluations by both the patients and investigators confirmed that meloxicam 15 mg in an intramuscular or oral formulation was effective in relieving pain in patients with acute sciatica. Meloxicam was generally well tolerated, and the local tolerability of the intramuscular injection was found to be excellent on the basis of both clinical evaluation and assessment of creatine phosphokinase levels.

Acute Disease↗

PubMed1983

Descriptions of pain and other sensory modalities in patients with lumbago-sciatica and herniated intervertebral discs. Interview administration of an adapted Mcgill Pain Questionnaire.

This paper aims at elucidating to what extent patients with lumbago-sciatica in the presence of an herniated intervertebral disc, are inclined to describe their pain in a characteristic way. The material comprised 50 patients with clinical and radiological signs indicating herniation of the L4/5 or L5/S1 discs. The assessment of pain was performed by formal oral interview, focussing on spatial distribution and somatosensory dimensions of pain in various regions of the back and leg. In conformity with the fact that a range of sensible nerves are affected by the herniation pain description is represented by a variety of pain qualities. The pattern of pain description tends to exhibit certain characteristic traits: only half of the patients had low-back pain, and pain was most frequently occurring in the gluteal region, thigh and calf. The frequency of superficially localized pain tended to increase in the proximo-distal direction. Aching-like pain was the most common pain quality, and this variant of pain as well as flashing and jerking sensations were commonly reported in the gluteal region, thigh and calf. Warmth was most frequently experienced in these regions, cold sensations in distal parts. A feeling of punctate pressure was common in the gluteal region, incisive pressure and paraesthesia in the thigh and calf, and a cramp-like feeling in the calf region. Reduced sensibility was frequently experienced in distal parts and never in the lumbar region. Pain quality differs in patients with a short and a long duration of the actual attack of sciatica. The mapping of pain seems to represent a diagnostical aid. A high degree of homogeneity of the patients is required for pain description to be a valid and reliable instrument. The clinical application of pain mapping is to be shown through a paper-and-pencil administration of a questionnaire based upon the findings from this study.

Adult↗

PubMed1996

Specificity of diagnostic nerve blocks: a prospective, randomized study of sciatica due to lumbosacral spine disease.

Temporary nerve blocks using local anesthetic are employed extensively in the evaluation of pain problems, particularly lumbosacral spine disease. Their specificity and sensitivity in localizing anatomic sources of pain have never been studied formally, however, and so their diagnostic and prognostic value is questionable. There have been anecdotal reports of relief of pain by temporary blocks directed to areas of pain referral, as opposed to areas of documented underlying pathology; but there has been no study to define the frequency or magnitude of this effect. We have examined the specificity and sensitivity of a battery of local anesthetic blocks in a series of 33 patients with a chief complaint of sciatica, attributable in all cases to spinal disease (radiculopathy, with some clinical features of arthropathy). As determined by blinded patient analog ratings in randomized sequence, three different nerve blocks were significantly more effective than control lumbar subcutaneous injection of an identical volume of 3 ml of 0.5% bupivacaine (P < 0.05). Not only paraspinal lumbosacral root blocks and medial branch posterior primary ramus blocks (at or proximal to the pathology), but also sciatic nerve blocks (distal or collateral to the pathology) produced temporary relief in a majority of patients. This confirmed the study hypothesis that false positive results are common, and specificity is low. For sciatic nerve blocks, specificity was between 24% and 36%. Patterns of responses specific to the established diagnosis of radiculopathy (i.e., root block most effective) had sensitivities between 9% and 42%. Statistical analysis of clinical and technical prognostic factors revealed that the only association with pain relief by any block were the effects of other blocks. The strongest association was between relief by sciatic nerve block and relief by medial branch posterior primary ramus (facet) block (P = 0.001, odds ratio 16.0). There were no associations between the results of blocks and clinical findings (history, physical examination, diagnostic imaging) in these patients, chosen for their homogeneous clinical presentation and absence of functional signs. Our findings indicate a limited role for uncontrolled local anesthetic blocks in the diagnostic evaluation of sciatica and referred pain syndromes in general. Negative blocks or a pattern of responses may have some predictive value, but isolated, positive blocks are non-specific. This lack of specificity may, however, be advantageous in therapeutic applications.

Adult↗