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PubMedDate not supplied

Trunk strengths in attempted flexion, extension, and lateral bending in healthy subjects and patients with low-back disorders.

Trunk strengths were measured in 27 health males and 30 health females, and in 25 male and 15 female patients with low-back pain and/or sciatica. Maximum voluntary isometric strengths were measured during attempted flexion, extension, and lateral bending from an upright standing position. Both male and female patients had approximately 60% of the absolute trunk strengths of the corresponding healthy subjects. Intra-individual trunk strength ratios were used to interpret the results. Use of these ratios tends to avoid interpretational problems created by the general weakness of the patients and any lack of motivation of either patients or healthy subjects. The ratios showed that the patients had attempted extension strengths that were significantly less than their strengths in the other types of movements tested. The strength ratios for attempted extension were particularly low for patients with sciatica.

Adult↗

PubMedDate not supplied

The intensity of work recovery in low back pain.

The intensity of work recovery in LBP has been studied using the National Health Register. Nine hundred forty men, 40-47 years old, were selected randomly from the census register of the city of Göteborg, Sweden. Sickness absence data were obtained from the Health Register, in which all sickness absence from age 16 is recorded. The rate of return to work decreases as expected with an increase in absence period. Different rates were found for different diagnoses, however, with low return intensities in patients with sciatica compared with those with back pain, ie, return to work was slower in patients with sciatica. Men with manual work had a significantly longer average sickness absence than white-collar workers. The intensity of work recovery was lower in blue-collar workers during the first 20 days of absence, while the reverse was true after 20 days of sickness absence, ie, the white-collar workers who were absent more than 20 days had a slower rate of recovery than blue-collar workers who had been absent for 20 days. Data as presented here can be used to study the effect of intervention (for example, manual therapy) on the natural course of work recovery. It also can be used, as above, to study differences in sickness absence patterns between different diagnoses and work groups.

Absenteeism↗

PubMedDate not supplied

Chymopapain for the treatment of intervertebral disc herniation. The final report of a double-blind study.

Sixty patients with unilateral sciatica resulting from lumbar intervertebral disc herniation were entered into a double-blind study. All patients had failed to respond to conservative management, and the diagnosis had been confirmed by metrizamide myelography. Following a randomized schedule, 30 patients had intradiscal injections of chymopapain, and 30 patients had intradiscal injections of an equivalent volume of normal saline solution. Two years after the injection, 77% of patients treated with chymopapain were assessed as moderately improved, compared with 47% of saline-injected patients. Fifty-seven percent of the chymopapain group were free of pain, compared with 23% in the saline group. Based on the late results of this study, chymopapain is recommended for the treatment of sciatica from intervertebral disc herniation when conservative measures have failed and before disc fragment excision is considered.

Analgesics↗

PubMedDate not supplied

Lumbar disc herniation in the elderly.

Thirty-two patients older than 60 years underwent surgical treatment for lumbar disc herniation over a 10-year period. Other causes of low-back pain and sciatica were investigated, and bony nerve root entrapment syndromes were not included. Sciatica was a predominant symptom and was present in all patients, with 81% showing positive nerve root tension signs. Motor deficit was found in more than half of the cases. A sequestrated disc was present in 50%. The follow-up ranged from 1 to 10 years with an average of 50 months. Eighty-seven percent of the patients had excellent or good results. There were no poor results and no one required reoperation. Lumbar disc herniation in the elderly is not a common problem, but surgery yields a high rate of satisfactory results if a proper investigation and correct diagnosis is obtained.

Aged↗

PubMed1992

Spinal mobility and trunk muscle strength in 15-year-old schoolchildren with and without low-back pain.

From a population of 1,503 schoolchildren, 38 15-year-old children suffering from low-back pain and 38 asymptomatic controls were selected for testing of spinal mobility and trunk muscle strength. The asymptomatic controls were matched by age, sex, and school class. In the group with recurrent or continual low-back pain (17 boys and 21 girls), the boys were over 4 cm taller than those in the control group. In both sexes sagittal mobility was decreased in lumbar extension and straight leg raising, and increased in lumbar flexion. Endurance strength in the abdominal and back muscles was decreased compared to the control pupils, who reported no back pain at all in the questionnaire collected 1 year before the testing procedure. The pupils reporting sciatica (n = 7) at some time, in addition to recurrent low-back pain, had decreased lumbar flexion and side bending compared to those with recurrent low-back pain (n = 31) without sciatica. The results of the study indicated that in this growing-age population there was a subgroup with recurrent low-back pain having a different spinal mobility pattern as well as decreased trunk muscle strength.

Adolescent↗

PubMed1995

The long-term effects of physical loading and exercise lifestyles on back-related symptoms, disability, and spinal pathology among men.

STUDY DESIGN: Historical cohort, including selected subgroups. OBJECTIVES: To understand the long-term effects of exercise on back-related outcomes, back pain, sciatica, back-related hospitalizations, pensions, and magnetic resonance imaging findings were studied among former elite athletes. SUMMARY OF BACKGROUND DATA: Exercise and sports participation have become increasingly popular, as have recommendations of exercises for back problems, but little is known about their long-term effects. METHODS: Questionnaires were returned by 937 former elite athletes and 620 control subjects (83% response rate). Identification codes allowed record linkage to hospital discharge and pension registers. Magnetic resonance images were obtained of selected subgroups with contrasting physical loading patterns. RESULTS: Odds ratios for back pain were lower among athletes than among control subjects, with significant differences in endurance, sprinting and game sports, and wrestling and boxing. No differences in the occurrence of sciatica or in back-related pensions and hospitalizations were seen. When comparing lumbar magnetic resonance images of 24 runners, 26 soccer players, 19 weight lifters, and 25 shooters, disc degeneration and bulging were most common among weight lifters; soccer players had similar changes in the L4-S1 discs. No significant differences were seen in the magnetic resonance images of runners and shooters. CONCLUSIONS: Maximal weight lifting was associated with greater degeneration throughout the entire lumbar spine, and soccer with degeneration in the lower lumbar region. No signs of accelerated disc degeneration were found in competitive runners. However, back pain was less common among athletes than control subjects and there were no significant differences in hospitalizations or pensions. No benefits were shown for vigorous exercise compared with lighter exercise with respect to back findings.

Adolescent↗

PubMed1995

Spinal nerve root compression.

The pathophysiology of sciatica is not completely understood, although our understanding of its causes is increasing. Mechanical alterations combined with inflammatory changes lead to pain. Compression alters nerve root conduction and compromises the nutritional support of spinal nerve roots (through intrinsic and extrinsic vascularity and cerebral spinal fluid percolation). Mechanical forces can lead to intraneural damage and functional changes in nerve roots. Chemical and metabolic effects can create an inflammatory response. Varying causes of inflammation coupled with varying degrees of compression can occur anywhere along the cauda equina or spinal nerve root, including the dorsal root ganglia, and contribute to the pain response and neurologic deficits associated with sciatica.

Animals↗

PubMed1998

Natural history of low back pain. A longitudinal study in nurses.

STUDY DESIGN: Longitudinal study. OBJECTIVES: To assess the natural history of low back pain. SUMMARY OF BACKGROUND DATA: Most episodes of low back pain resolve or improve within a few weeks, but chronic or recurrent symptoms are common. Previous studies of natural history have usually relied on people's long-term recall of symptoms, or they have been limited to patients seeking clinical care. METHODS: Nurses (1,165 women) completed a baseline questionnaire and up to eight follow-up questionnaires 3 months apart. Each questionnaire asked whether they had experienced low back pain in the past month. One-month prevalences of pain at specified follow-ups were calculated according to histories of pain reported on earlier questionnaires. RESULTS: The 1-month prevalence of low back pain at individual follow-ups ranged from 16% to 19%. Of 906 women who completed the baseline questionnaire and at least three follow-up questionnaires, 38 (4.2%) reported pain every time they returned a questionnaire, and 190 (21.0%) reported pain on at least three occasions. The presence or absence of low back pain at baseline was highly predictive of future pain throughout follow-up. The longer that back pain was consistently reported, the more likely it was to be present at the next follow-up. Later risk was lowest in women who reported no back pain at baseline or either of the first two follow-ups. Back pain carried a worse prognosis if it was disabling or associated with sciatica. CONCLUSIONS: Our results confirm the importance of back pain duration and the occurrence of associated disability and sciatica as predictors of future symptoms, and allow more reliable quantification of the natural history of back pain in women of working age. In the absence of other information, the differentials in risk associated with a person's history of back pain appear to remain constant for a period of at least 2 years.

Adult↗

PubMed2001

Severity of symptoms and signs in relation to magnetic resonance imaging findings among sciatic patients.

STUDY DESIGN: A cross-sectional study in sciatic population. OBJECTIVES: To evaluate the separate roles of nerve root entrapment-based on magnetic resonance imaging-and other discogenic pain mechanisms on disability and physical signs among symptomatic sciatic patients. SUMMARY OF BACKGROUND DATA: Data symptoms of sciatica are generally understood to be generated by nerve root compression, but other pain mechanisms of sciatica have been suggested. METHODS: The authors obtained magnetic resonance scans from 160 patients with unilateral sciatic pain. The patients reported the intensity of their back and leg pain and their back-specific disability. Clinical examination and magnetic resonance imaging (1.5 T) was performed on every patient. The degree of disc displacement, neural enhancement, and nerve root compression was evaluated from magnetic resonance scans. The correlations of symptoms and signs with magnetic resonance imaging findings were calculated. RESULTS: The degree of disc displacement in magnetic resonance imaging did not correlate with any subjective symptoms, nor did nerve root enhancement or nerve compression. Magnetic resonance imaging classification was associated, however, with straight leg raising restriction. In regression analysis, straight leg raising restriction was best explained with a simple classification of nonherniations versus herniations. CONCLUSIONS: The results suggest that a discogenic pain mechanism other than the nerve root entrapment generates the subjective symptoms among sciatic patients. The findings of this study thus indicate that magnetic resonance imaging is unable to distinguish sciatic patients in terms of the severity of their symptoms.

Adult↗

PubMed2001

Health-related quality of life and somatization in patients with long-term low back pain: a prospective study with 109 patients.

STUDY DESIGN: For this study, a prospective cohort of 109 patients was recruited consecutively at an orthopedic inpatient unit of a university hospital. Three self-report instruments were administered to patients with sciatica believed to be caused by a herniated lumbar disc to examine their quality of life and psychic stress at baseline and at the 1-year follow-up visit. OBJECTIVES: To investigate whether patients who have undergone a previous discectomy experience greater psychic stress than patients with no surgery, and to determine whether the groups differed regarding their health-related quality of life at the follow-up visit. SUMMARY OF BACKGROUND DATA: Previous studies have described psychic abnormalities in patients with long-term back pain, particularly patients with severe chronicity (i.e., history of surgeries and persistent problems) or those who underwent a previous discectomy. Additionally, a series of studies has shown that psychic and psychosocial parameters exert a significantly greater influence on the success of treatment than do clinical and imaging findings or the extent of disc abnormality. METHODS: The Short Form Health Survey 36, the Symptom Checklist 90, and Screening for Somatoform Disorders were administered to 109 patients consecutively treated in the authors' orthopedic university clinic, at baseline and at the 1-year follow-up visit. RESULTS: In all the patients examined, the physical and mental quality of life improved regardless of their group classification. The psychological distress, according to the Symptom Checklist 90, was clearly reduced in both groups at the follow-up visit, with the exception of somatization, as indicated by Symptom Checklist 90 and Screening for Somatoform Disorders. Whereas the patients who had undergone surgery remained nearly unchanged with regard to their somatization, the patients with no previous surgery improved significantly, as indicated by Screening for Somatoform Disorders and Symptom Checklist 90. Somatization, particularly that surveyed by the comprehensive Screening for Somatoform Disorders, proved to be quite a stabile factor over time in both groups. The extent of the physical impairment before treatment was nearly the same in both groups, as indicated by Short Form Health Survey 36. Despite a markedly higher chronicity of reported problems, patients who had undergone surgery were hardly more greatly impaired in terms of their mental quality of life and psychological distress, as indicated by Symptom Checklist 90, than those without a history of surgery. At the follow-up visit, the differences tended to be minimal as well. As compared with those who had no previous surgeries, the patients who had undergone surgery were significantly more heavily impaired in their physical quality of life despite significant improvements. CONCLUSIONS: Patients with sciatica demonstrated less abnormality in terms of the psychopathologic markers investigated than described in previous studies. Nevertheless, the predisposition to somatize influences health-related quality of life to a high degree.

Adult↗

PubMed2002

Bilateral symptomatic synovial cysts of the lumbar spine caused by calcium pyrophosphate deposition disease: a case report.

STUDY DESIGN: A case of bilateral symptomatic facet joint synovial cysts arising in association with calcium pyrophosphate deposition disease is reported. OBJECTIVE: To present a previously unreported cause for symptomatic synovial cysts of the lumbar spine. SUMMARY OF BACKGROUND DATA: Synovial cysts of the facet joints occur most commonly in association with degenerative disease of the spine in older individuals. The association of these cysts with trauma, rheumatoid arthritis, spondylolysis, and kissing spinous processes also has been reported. These cysts can cause symptoms and signs from direct compression of the dura. Chondrocalcinosis has not been previously reported to cause symptomatic synovial cysts. METHODS: A 67-year-old woman presented with right lower limb sciatica caused by a right L4-L5 facet joint cyst, which resolved after surgical decompression. A year later, she presented with left lower limb sciatica caused by development of a new L4-L5 facet joint cyst, which also resolved after surgical decompression. RESULTS: Histopathologic examination of each cyst showed a cyst wall of fibrous tissue with synovial lining, inflammation, and granulation tissue. Examination of the tissue under polarized light showed positively birefringent, short blunt crystals of calcium pyrophosphate dihydrate. CONCLUSIONS: In patients with a history of gout or pseudogout, a rare possibility of a synovial cyst should be considered in the differential diagnosis during investigation for the cause of neural compression resulting in sciatic syndrome.

Aged↗

PubMed2003

Proximal neuromuscular impairment in lumbar disc herniation: a prospective controlled study.

STUDY DESIGN: A prospective and controlled study investigated the relation of muscle dysfunction to residual pain and disability in patients with lumbar disc herniation. OBJECTIVES: To determine the incidence of lower limb muscle dysfunction in lumbar disc herniation and its evolution over time after surgery, and to ascertain whether neuromuscular dysfunction has a prognostic value regarding pain and disability. SUMMARY OF BACKGROUND DATA: Residual sciatica, low back pain, and disability are common after lumbar discectomy. Preoperative motor dysfunction corresponding to the afflicted nerve root is often seen. METHODS: The participants in this study were 71 patients, ages 15 to 50 years, with disc prolapse at L4-L5 or L5-S1. Before surgery, then 6 weeks, 4 months, and 12 months after surgery, low back pain and leg pain were estimated on a visual analog scale, and disability was determined according to the Roland-Morris Questionnaire and a designed functional muscle test. RESULTS: Motor function of the sciatic leg frequently was impaired. Inferior outcome of proximal motor tests 6 weeks after surgery predicted pain and disability 1 year after surgery. The mean leg pain was 59 mm before surgery and 15 mm at 6 weeks, remaining at that level during the follow-up period. The mean disability score was 14.4 before surgery, 8.8 at 6 weeks, and 4.7 at 4 and 12 months, whereas muscle function improved gradually through 1 year of follow-up evaluation. CONCLUSIONS: Neuromuscular dysfunction frequently is present in patients with lumbar disc herniation. Sciatica resolves quickly after surgery, whereas disability improves gradually up to 4 months and muscular performance improves throughout the first year. Proximal muscular dysfunction in lumbar disc herniation has a prognostic value concerning residual pain and disability.

Adolescent↗

PubMed2003

The extraforaminal juxtafacet cyst as a rare cause of L5 radiculopathy: a case report.

STUDY DESIGN: This is a report of a case. OBJECTIVE: To document the clinical, radiographic, and histologic characteristics of a lumbar extraforaminal juxtafacet cyst. SUMMARY OF BACKGROUND DATA: Spinal juxtafacet cysts develop most frequently at the dorsal aspect of the zygapophysial joint, sometimes in the posterolateral area of the canal. In one case, they have been described in the foraminal and extraforaminal region. METHODS: Description of the case report. RESULT: The authors report one case of a strictly extraforaminal juxtafacet cyst responsible for L5 sciatica. CONCLUSIONS: Juxtafacet cysts of the spine represent an infrequent cause of sciatica, usually when they grow in the canal, or more exceptionally when they occupy the foraminal or extraforaminal areas.

Bone Cysts↗

PubMed2004

Primary hydatid disease of sacrum affecting the sacroiliac joint: a case report.

STUDY DESIGN: A case report of hydatid disease of the spine. OBJECTIVE: To describe an unusual case of hydatid disease of the sacrum affecting the sacroiliac joint and to discuss imaging, differential diagnosis, and treatment. SUMMARY OF BACKGROUND DATA: Hydatidosis or echinococcosis affecting the spine is rare and has a characteristic geographic distribution. Signs of sacroiliac joint involvement and accompanying neurologic deficits cause difficulties in differential diagnosis of this rare condition. METHODS: A case of 38-year-old female patient with low back pain and sciatica was presented. RESULTS: Plain radiographs, computed tomography, and magnetic resonance imaging scans revealed destructive expansive lesion located on the right sacrum and extended through the right sacroiliac joint. Surgical enucleation of the cysts was performed together with mebendazole treatment and histopathologic examination confirmed hydatidosis. CONCLUSION: This unusual disease should be kept in mind in the differential diagnosis of sacroiliac pain and sciatica, especially in endemic areas.

Adult↗

PubMed2004

Epidural venous plexus enlargements presenting with radiculopathy and back pain in patients with inferior vena cava obstruction or occlusion.

STUDY DESIGN: In the last 2 years, we have examined 9640 patients experiencing back pain or sciatica, using MRI. There were 13 (0.13%) patients who had radicular symptoms that clinically mimicked lumbar disc herniation or spinal stenosis. All of these patients had inferior vena caval obstruction or occlusion that caused engorgement in the epidural and paravertebral venous system, causing nerve root compression. OBJECTIVE: To illustrate the imaging characteristics of 13 patients with epidural engorged veins due to inferior vena cava obstruction or occlusion causing sciatica and low back pain. SUMMARY OF THE BACKGROUND DATA: Abnormalities or pathological changes of epidural venous network may give rise to symptoms similar to or mimicking lumbar disc herniation or spinal stenosis. Multiple lumbar epidural varices can cause nerve root and thecal sac compression. Lumbar epidural varices have been infrequently described in the literature. To date, the cause of anterior epidural venous enlargement has been poorly understood, and both congenital and acquired causes have been proposed. This report describes enlarged epidural veins in patients with inferior vena caval thrombosis or obstruction presenting with radicular syndromes. METHODS: The authors have seen 13 patients with radicular symptoms. All of the patients had inferior vena caval obstruction or occlusion that caused engorgement in the epidural veins, causing nerve root compression. The ages of these patients ranged from 20 to 53 (mean, 30) years. All of the patients were examined with color Doppler ultrasonography and magnetic resonance scanner. RESULTS: Ten of 13 patients had inferior vena cava thrombosis located just under the renal vein orifices. In two patients, there was compression to inferior vena cava due to parity. In the remaining patient, a huge intra-abdominal mass was observed, and this mass was causing inferior vena cava obstruction and invasion. Enlargements of epidural venous plexus were demonstrated in all of these cases. All of the patients presented with the acute onset of low back pain followed shortly thereafter by acute radicular symptoms. The compression to inferior vena cava could not be treated in one patient because of intra-abdominal malignancy. The remaining 12 patients with inferior vena cava obstruction or occlusion experienced complete resolution of symptoms after treatment or delivery. CONCLUSION: The authors believe that epidural venous engorgement should be considered when the symptoms of patients with deep venous and inferior vena cava thrombosis are accompanied by radicular and/or back pain, because pathologic processes compressing a nerve root can cause pain.

Abdominal Neoplasms↗

PubMed2005

The mannequin sign.

STUDY DESIGN: Prospective observational study. OBJECTIVES: The critical appraisal of the mannequin sign in the validation of patients with symptoms of sciatica. SUMMARY OF BACKGROUND DATA: Sixty-five consecutive patients with magnetic resonance imaging-proven lumbar disc herniation and symptoms of sciatica. Mean patient age was 48 (range 28-62) years. Thirty-seven patients were male and 28 were female. METHODS: The mannequin sign is positive when a patient adopts an antalgic posture with the relevant lower limb flexed at the hip and knee with the pelvis tilting towards the affected side, in the classic manner of a mannequin's pose. Reproducibility of the sign was recorded when all patients were examined by a second clinician. Lumbar disc herniation with nerve root impingement was confirmed by magnetic resonance imaging. RESULTS: The mannequin sign had 100% reproducibility and 80% sensitivity in diagnosing lumbar disc herniations with nerve root impingement. Twenty-four patients had L4-L5 disc herniations and 41 had L5-S1 disc herniations. CONCLUSION: Astute clinical examination can minimize inaccurate diagnosis, unnecessary investigations, and even inappropriate surgical intervention. The mannequin sign, first observed and anecdotally reported by the senior author (D.C.), has now been critically appraised.

Adult↗

PubMed2006

Determinants of spontaneous resorption of intervertebral disc herniations.

STUDY DESIGN: A follow-up of disc herniation (herniated nucleus pulposus [HNP]) resorption on magnetic resonance imaging (MRI). OBJECTIVE: To assess the determinants of resorption of HNP. SUMMARY OF BACKGROUND DATA: Neovascularization in the outermost areas of HNP, presenting as an enhancing rim in gadolinium diethylenetriamine pentaacetic acid MR images, is thought to be a major determinant of spontaneous resorption of HNP. METHODS: Patients with HNP-induced sciatica at baseline were rescanned at 2 months (N = 74) and after 12 months (N = 53). The volume of HNP (mm), thickness (mm) and extent (%) of enhancement, and the degree of HNP migration (Komori classification) were analyzed. Repeated measures analysis of covariance was used in statistical analysis. RESULTS: Significant resorption of HNP occurred from baseline to 2 months, although the resorption rate was more pronounced over the whole 1-year follow-up. Higher baseline scores of rim enhancement thickness, higher degree of HNP displacement in the Komori classification, and age category 41-50 years were associated with a higher resorption rate. Thickness of rim enhancement was a stronger determinant of spontaneous resorption than extent of rim enhancement. Clinical symptom alleviation occurs concordantly with a faster resorption rate. CONCLUSIONS: MRI is a useful prognostic tool for identifying patients with HNP-induced sciatica with a benign natural course.

Adult↗

PubMed1994

Comparative health status of patients with 11 common illnesses in Wales.

OBJECTIVE: To assess the health status of patients with 11 common illnesses--asthma, diabetes, arthritis, back pain, sciatica, hypertension, angina, anxiety, depression, and heart attack and stroke. DESIGN: Face to face interview using a structured questionnaire which contained the Short Form 36 questionnaire (SF-36) and questions on lifestyle, health service utilisation, and self reported conditions treated by physicians. SETTING: Patients' homes, in West Glamorgan, Wales. SUBJECTS: Twelve hundred adults, aged 20-89 years, were randomly selected from the register of the family health services authority. MAIN OUTCOME MEASURES: The eight scales within the SF-36 health profile. RESULTS: The response rate was 82%. Each illness had a distinctive profile; patients with anxiety or depression reported the worst health experience in role limitations because of emotional problems and mental health, while patients with back pain, arthritis, or sciatica registered the three highest negative scores in bodily pain and role limitations due to physical problems. For all disease groups, the general health perceptions of those with the disease was significantly worse than those without it (p < 0.01). CONCLUSIONS: The SF-36 allows comparison of the health status of patients suffering from different conditions. Data such as these can be used to inform better purchasing decisions on how resources might be more effectively deployed and as a bench mark to monitor the effects of multiple health care interventions by conducting serial surveys.

Adult↗