SEARCH · PubMed Health

Results for “Sciatica”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,693 records · Page 94Linked to original sources

PubMed1994

Physician variation in diagnostic testing for low back pain. Who you see is what you get.

OBJECTIVE: This study examined patterns of diagnostic test use for patients with low back pain. Three specific questions were addressed: 1) What tests do physicians recommend for patients with 3 common types of low back pain? 2) Do physicians in various specialties differ in the tests they would order? and 3) How appropriate are physicians' choices of tests, based on current medical knowledge and expert recommendations? METHODS: A stratified national random sample of 2,604 physicians in 8 specialties was mailed questionnaires asking about the tests they would order for hypothetical patients with acute back pain, sciatica, or chronic low back pain. Physicians were also asked which procedures they generally used to evaluate suspected lumbar nerve root compression. These responses were compared with guidelines that have been suggested by the Quebec Task Force on Spinal Disorders, based on comprehensive evaluation of the scientific literature. RESULTS: Approximately 1,100 physicians responded to the survey (43% response rate). Magnetic resonance imaging was the most frequently used procedure for evaluating suspected lumbar nerve root compression, although a majority of neurosurgeons would still use myelography. Neurosurgeons and neurologists were twice as likely as other specialists to order an imaging study for patients with acute nonradiating pain or chronic back pain. Physiatrists and neurologists were more than 3 times as likely as other specialists to order electromyograms for acute back pain with sciatica or chronic back pain. Rheumatologists were almost twice as likely as other specialists to order laboratory tests for both acute and chronic back pain. The reported use of imaging and electrodiagnostic tests was generally premature and more extensive than that recommended by the Quebec Task Force. CONCLUSION: There is little consensus, either within or among specialties, on the use of diagnostic tests for patients with back pain. Thus, the diagnostic evaluation depends heavily on the individual physician and his or her specialty, and not just the patient's symptoms and findings. Furthermore, many physicians may be ordering imaging studies too early and for patients who do not have the appropriate clinical indications. These results suggest a need for additional clinical guidelines as well as better adherence to existing guidelines.

Diagnostic Tests, Routine↗

PubMed2001

Reliability and responsiveness of the shuttle walking test in patients with chronic low back pain.

BACKGROUND AND PURPOSE: Walking is an important functional activity and the shuttle walking test has been shown to be a useful test for patients with chronic airways obstruction and heart failure. The test has been used in low back pain research over recent years and has increasingly been used as an outcome measure to investigate treatment efficacy in patients with low back pain. The aim of the present study was to determine the reliability and responsiveness of the shuttle walking test within a group of patients with low back pain (with or without sciatica). METHOD: Reliability of the shuttle walking test was determined on a group of patients with low back pain (n = 44) using the Bland and Altman (1986) limits of agreement and the intraclass correlation coefficient (ICC). Responsiveness was assessed using the standardized effect size. The mean distance walked within a patient population (n = 337) was compared with an age- and sex-matched group of healthy subjects (n = 122). RESULTS: The shuttle walking test obtained an ICC score of 0.99, whereas the limits of agreement test gave a mean difference of 2.5 m with upper and lower limits of agreement of 52 m and -47 m, respectively. Patients undertaking fitness training reached an effect size of 1.2 compared to a control group of 0.23 and 0.94 for a group undergoing various orthopaedic treatments. CONCLUSIONS: The present study has shown that the shuttle walking test is a reliable and responsive test within a group of patients with low back pain, with or without sciatica. It is simple to administer and provides a quick method of measuring one aspect of a patient's physical function.

Adult↗

PubMed1996

Epidemiological aspects and risk factors for low back pain in 38-year-old men and women: a 25-year prospective cohort study of 640 school children.

This study is based on data gathered by means of a postal questionnaire from a cohort of 640 38-year-old subjects. At the age of 14 years these subjects had been interviewed by their school doctor to ascertain whether any of them had a history of low back pain (LBP), and X-rays of the thoracic and lumbar spine were taken. The questionnaire contained related groups of questions, with LBP as the main topic. We wanted to identify probable risk factors in developing LBP. The results show a cumulative life-time prevalence of LBP of 70%, a 1-year prevalence of 63% and a point prevalence of 19%, independent of gender. Women reported a higher incidence of LBP than men during the month and week before they filled out the questionnaire, they also reported a higher incidence of sciatica and greater use of the health care system and analgestics over the previous year. Heavy manual work was associated with LBP and sciatica, and smoking (more than 16 cigarettes per day) was more common among unemployed and sick-listed subjects, Severe LBP was associated with increased morbidity, reduced work capacity, deterioration in social life, mental and sexual problems, and increased smoking. A stepwise logistic regression analysis of "early" independent variables indicated that severe LBP is positively correlated with low social class for men and with menstruation and pregnancy for women.

Adolescent↗

PubMed1988

Radiology of posterior lumbar apophyseal ring fractures: report of 13 cases.

The authors report radiological findings in 13 cases of avulsion of the posterior lumbar apophyseal ring. The lesion affected young adults in 10 cases and adolescents in 3 cases. The lesion involved the inferior endplate of L4 in 11, and of L5 in 1 patient, and of L3 in 1 patient. 6 patients presented with unilateral sciatica, 3 with bilateral sciatica, and 4 with low back pain. Acute spinal trauma was evident only in 2 adolescents. Radiological recognition of the lesion was possible on plain films in 9 cases. CT demonstrates association of avulsion of the posterior vertebral apophyseal ring and herniated disc in all cases. Avulsion of the posterior apophyseal ring has to be differentiated from posterior longitudinal ligament, annulus, or herniated disc calcifications, as well as from posterior degenerative ridge osteophytes. Controversy about physiopathology of the lesion remains: weakness of the apophyseal ring during childhood and in patients with Scheuermann's disease may explain avulsion of the apophyseal ring in association with median disc herniation.

Adolescent↗

PubMed1976

[Intrathecal cortison injection in lumbar disc problems (author's transl)].

Intrathecal instillation of corticosteroid was used in treatment of 188 patients with persistent sciatica or lumbar pain caused by disc hernia or osteochondrosis and recurrent sciatica or lumbar pain after disc operation. 88 of 122 own patients were followed up. Indication, mechanism of steroid action, technic, complications and results are discussed. According to the good results in part of the patients, still after years, the authors believe, that intrathecal corticosteroid administration is a further useful method of conservative treatment of degenerative lumbar disc affections. This therapy can also be used in patients with recurrent, persistent lumbar or leg pain after disc operation.

Adult↗

PubMed1993

Surgical treatment of Bertolotti's syndrome. Follow-up of 16 patients.

We surgically treated 16 patients with Bertolotti's syndrome (chronic, persistent low back pain and radiographically diagnosed transitional lumbar vertebra). Eight had posterolateral fusion and another eight resection of the transitional articulation. Thirteen patients had in addition to the chronic low back pain, suffered from repeated episodes or chronic sciatica. In six cases with resection treatment, local injections were administered at the transitional articulation before deciding for resection of the transitional joint; each patient reported transient relief of pain, while this preoperative test did not correlate with successful outcome of treatment. Six patients had to be treated with second operations. Ten of the 16 operatively treated patients showed improvement of the low back pain, and this result was similar in the group treated with fusion and in that treated with resection. Seven had no low back pain at follow-up, and the improvement according to the Oswestry pain scale was similar in the two groups, and statistically significant. Eleven patients still had persisting episodes of sciatica (versus 13 preoperatively). The average disability according to the Oswestry total disability scale was 30%, corresponding with moderate outcome, and both operatively treated groups did equally well. At follow-up the first disc above the fused segments was found to be degenerated in seven out of eight cases, and in the group treated with resection the first disc above the transitional vertebra was degenerated in five cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1984

Myelographic versus clinical diagnostics in lumbar disc disease.

The series consisted of 200 patients on whom lumbar myelography was performed for sciatica. After myelography, a disc operation was carried out on 95 patients. The episode of sciatica was the first for 90 patients. Objective neurologic signs were present in 185 patients, while 15 had only subjective symptoms. Definite or possible disc herniation was revealed by myelography in 66%. Most positive findings were located at the L4-L5 interspace. The clinical diagnostic accuracy rate was assessed from the patients' histories. As confirmed by operation, the accuracy of the clinical diagnostics was 52%, and the accuracy rate of myelography was 90%. The rate of false positive findings in myelography was 4%, that of false negative findings 6%. When the clinical or myelographic diagnosis was definitive, a disc herniation or protrusion was always found at operation. Almost one fourth of the clinically diagnosed definite herniations were not treated surgically because myelography proved negative. One fifth of those patients in whom myelography revealed an unequivocal disc herniation were not operated on because these patients had clinically improved before being admitted to myelography. The results of this study justify the following conclusions: the clinical level diagnostics of a disc herniation is rather unreliable, and myelography is therefore always indicated before operation; myelography should only be performed in those cases in which there is a clear clinical indication for surgery; myelography ought to be performed within 1 week; an unequivocal positive finding in myelography predicts a good operative result.

Adolescent↗

PubMed1982

Lumbar spondylolisthesis. Clinical syndrome and operative experience with Cloward's technique.

The paper gives a survey, based on literature reports and our own experiences in 59 cases. According to Kilian (1853) spondylolisthesis is defined as ventral slipping of a vertebral body together with the pedicles. In pseudospondylolisthesis (Junghanns) the whole vertebra slips ventrally. Elongation of the isthmus of the pedicle or a cleft in the interarticular portion are prerequisites for spondylolisthesis. A dysplastic origin during childhood and adolescence is assumed. The relation of males to females is 2 : 1. Evolution of spondylolisthesis occurs during childhood and adolescence. The slipping process is finished in adults. Most often the condition is encountered in the lumbar, in particular in the lumbosacral, region. A third to one half of patients with spondylolysis (5-7%) demonstrate spondylolisthesis. Spondylolisthesis is usually an accidental finding, although the condition may lead to low back pain and sciatica. The earlier symptoms arise the gloomier usually is the prognosis. Very rarely a herniated disc in the cause of symptoms. Sciatica is mostly due to irritation of a nerve root by compression on the vertebral edge. Low back pain is caused by arthrogenic, pseudoarthrotic, and spondylotic degenerative disease. Diagnosis is established by AP, lateral, and oblique X-rays, and functional investigations. Myelogram and ossovenogram demonstrate compression of caudal sac and nerve roots. Conservative treatment consists of drugs and physical therapy, and cures one fifth of the patients. The best operative results are found after decompression and stabilisation (Cloward).

Adolescent↗

PubMed1989

Hydatid disease affecting the vertebrae.

Six cases of hydatid disease affecting the vertebrae are described. Four patients presented with paraparesis and sphincter disturbances while the other two presented with low back pain and sciatica. Myelographic findings were positive in all six patients. The CT scans showed a paravertebral mass with destruction of bone in two cases. The nuclear magnetic resonance performed in one patient showed the exact extent of the disease all along the spine. Posterior laminectomy with decompression of the spinal cord and removal of the hydatid cysts was performed in all six patients. After the operation four patients received oral treatment with mebendazole. The patients with paraparesis showed little improvement of their neurological status. The two patients with low back pain and sciatica showed marked improvement. Hydatid disease affecting the vertebrae presents with neurological complications due to cord compression. The prognosis remains poor in spite of laminectomy, although removal of the hydatid cysts and long-term mebendazole medication may result in relief of symptoms.

Adult↗

PubMed1986

Sciatic neuropathy at the popliteal fossa: clinical, ultrasonographic and computed tomographic diagnosis.

A 22-year-old female had been suffering from sciatica-like pain in the left leg for four years. Clinical findings strongly directed further investigations to the popliteal fossa. Ultrasonography located a hypoechogenic mass in the upper lateral popliteal space. Guided by these data, computerized tomography (CT) with vertical reconstructions made the tentative diagnosis of a common peroneal nerve tumor, which was confirmed at operation. Microscopic examination showed a neurinoma of the mixed neurilemmoma-neurofibroma type. In the presence of atypical features of sciatica, a high index of suspicion seems advisable. Emphasis is laid on the complementary contribution of ultrasonography and CT in this type of ill-defined lower limb pain.

Adult↗

PubMed1987

Chemonucleolysis of lumbar intervertebral disc prolapse with chymopapain: outcome after 1 year.

One hundred and one consecutive patients with lumbar disc prolapse were treated by chymopapain chemonucleolysis and their response and favourable pre-treatment criteria determined. Most improvement occurred within the first month, and one year after treatment outcome was judged satisfactory (excellent or good) in 71%. Individual patient characteristics associated with a satisfactory response were sciatica of greater severity than back pain (p = 0.005) and duration of symptoms less than 18 months (p = 0.03). Patients fulfilling 3 or 4 of four immediate pre-treatment clinical and radiographic criteria (sciatica more severe than back pain, reduced straight leg raising, neurological deficit, radiographic abnormality) had a satisfactory response more often than others (p less than 0.05). Reported success one year after surgery for disc prolapse is similar. Chemonucleolysis, however, requires less resources and does not preclude subsequent operation. Our results therefore suggest that it might be considered an alternative to surgery when conservative treatment has failed.

Adolescent↗

PubMed1993

Surgery for herniated lumbar discs: a literature synthesis.

OBJECTIVE: To assess the risks and benefits of surgery for herniated lumbar discs (discectomy) and to evaluate the methodologic quality of the literature. DESIGN: Literature synthesis. STUDY SELECTION AND DATA ANALYSIS: A structured MEDLINE search identified studies of standard, microsurgical, or percutaneous discectomy. Eligible studies had adult subjects, sample sizes of > or = 30, clinical outcome data for > or = 75% of patients, and follow-up of > or = 1 year. Summary rates of successful outcomes, reoperations, and complications were obtained by a random-effects logistic regression model. Methodologic quality was assessed using established study design criteria. RESULTS: Eighty-one studies met inclusion criteria. Most had substantial design flaws and/or omitted important clinical data. Randomized trials of standard discectomy showed better short-term sciatica relief following surgery; 65% to 85% of patients reported no sciatica one year after surgery, compared with only 36% of conservatively treated patients. No data from randomized trials were available for microdiscectomy or percutaneous discectomy, although most outcomes appeared comparable to those of standard discectomy. Approximately 10% of discectomy patients underwent further back surgery, and rates increased over time. The rate of serious complications, including death and permanent neurologic damage, was less than 1%. CONCLUSIONS: Most studies were poorly designed and reported. Standard discectomy appears to offer better short-term outcomes than does conservative treatment, but long-term outcomes are similar. Discectomies are relatively safe procedures, though reoperations are common and increase over time. Decisions for elective surgery must balance faster pain relief against the risks and costs of surgery.

Diskectomy↗

PubMed1997

Giant lumbar meningioma: a common tumour in an unusual location.

We report a 27-year-old woman with atypical sciatica due to a giant, rapidly growing, lumbar (T12-S1) meningioma. The unique features of this case are discussed and the importance of early investigation by MRI of patients with atypical low back pain and sciatica is highlighted.

Adult↗

PubMed1997

Pelvic stress injuries: the relationship between osteitis pubis (symphysis pubis stress injury) and sacroiliac abnormalities in athletes.

OBJECTIVE: To demonstrate with radiographic imaging the association between pubic stress injury and sacroiliac abnormalities in athletes. DESIGN AND PATIENTS: Eleven athletes (9 men and 2 women), comprising seven male long-distance runners, one male soccer player, one male and two female basketball players, were imaged with plain films for complaints of pubic symphysis pain, sciatica, groin pain, or a combination of these complaints. In addition to the plain films, four patients were imaged with CT, two patients had MR imaging, and a bone scan was performed in three patients. Anteroposterior plain films of the pelvis of 20 patients without back pain or pubic pain were evaluated for comparison as a control group (ages 18-72 years, average 49 years; 11 women and 9 men). RESULTS: All athletes showed plain film evidence of either sclerosis, erosions or offset at the pubic symphysis. Four had avulsion of cortical bone at the site of insertion of the gracilis tendon. Four patients demonstrated sacroiliac joint abnormalities on plain films consisting of sclerosis, erosions and osteophytes, and in one of these athletes, bilateral sacroiliac changes are present. Two patients with normal sacroiliac joints on plain films had a bone scan showing increased radionuclide uptake bilaterally at the sacroiliac joints. One patient with both plain film and CT evidence of sacroiliac abnormalities had an MR examination showing abnormal signal at both sacroiliac joints and at the pubic symphysis. A sacral stress fracture was found on CT in one patient with complaints of sciatica. In the control group, six patients, all over the age of 55 years, had mild sclerosis of the symphysis, but no plain film evidence of sacroiliac abnormalities. CONCLUSION: We have found a group of athletes in whom stress injuries to the pubic symphysis are associated with changes in the sacroiliac joint as demonstrated by degenerative changes or in the sacrum as manifested as a sacral stress fracture. These findings are probably due to abnormal stresses across the pelvic ring structure that lead to a second abnormality in the pelvic ring. The abnormality in the sacrum is not always well seen with conventional imaging. Recognition of the association of stress injury of the symphysis with back pain is important in that it can help avoid inappropriate studies and diagnostic confusion.

Adolescent↗

PubMed2002

The significance of spinal canal dimensions in discriminating symptomatic from asymptomatic disc herniations.

Spinal canal dimensions are assumed to play a significant role with regard to the development of symptoms in individuals with disc herniations. The literature is inconclusive on the significance of spinal canal size as a risk factor for sciatica, mainly because of study design problems. The objective of this study, therefore, was to test the hypothesis that spinal canal dimensions are a significant risk factor for the development of sciatica, comparing symptomatic and asymptomatic individuals. Thirty symptomatic patients undergoing lumbar discectomy and 45 asymptomatic volunteers were investigated by clinical and MRI examination. The size of the spinal canal and thecal sac as well as the midsagittal spinal canal diameter were measured using a point counting method and scanner software, respectively. Differences between the groups were compared separately for each level L3/4 to L5/S1. The intra- and inter-observer error ranged between 0.95 and 0.99 for all measurements. In symptomatic patients, the dimensions of the spinal canal and thecal sac as well as the midsagittal spinal canal diameter were smaller at all disc levels. Unpaired t-test demonstrated a significant difference, ranging from P<0.05 to P<0.001. When controlled for age, sex and body height, the odds ratio for a symptomatic disc herniation increased to as high as 35, depending on the spinal level, when the size of the spinal canal was smaller than the mean for controls by two standard deviations or more. In symptomatic patients, spinal canal dimensions are significantly smaller than those in asymptomatic individuals. Spinal canal dimension is an important factor discriminating patients from control subjects. A clinically relevant grading system for disc herniation should therefore be based on the spatial relationship between herniated disc material and neurogenic structures.

Adult↗

PubMed2005

Comparison of postural control in unilateral stance between healthy controls and lumbar discectomy patients with and without pain.

MAIN PROBLEM: Previous studies have demonstrated that sciatica patients have poorer postural control than healthy controls and that postural control remains unchanged 3 months after lumbar discectomy in sciatica patients. The aims of the current study were to investigate whether static balance control recovers in pain-free discectomy patients long-term after lumbar discectomy. Next is to determine whether static balance responses of asymptomatic and symptomatic lumbar discectomy patients differed from each other and from healthy controls. In addition, the influence of the extent of disc resection (unilateral/bilateral removal) and the side of operation on static balance control were investigated. METHODS: Fifteen pain-free lumbar discectomy patients, 23 lumbar discectomy patients with residual pain and 72 controls performed unilateral stance tasks with eyes open and eyes closed on a force plate were taken up for the investigation. Three repetitions of a 10 s unilateral stance test were performed on each leg. Postural sway was determined. Patients were divided into three age groups. RESULTS: In the eyes open condition, there was no significant difference between postural sway of pain-free lumbar discectomy patients and controls (P=0.68), whereas balance of patients with pain was significantly worse than in controls (P=0.003). In the eyes closed condition, the sway in both groups of lumbar discectomy patients was significantly worse than in controls (pain-free P=0.009/painful P<0.001). No significant differences were found in postural sway between patients with unilateral and bilateral disc resection. In unilateral stance on the leg of the operated side, centre of gravity sway was not significantly different in the eyes open condition compared to the eyes closed condition, whereas in stance on the leg of the non-operated side, postural sway was significantly lower in the eyes open condition compared to the eyes closed condition. In both conditions, postural sway in the age group of 50-65 years was significantly higher than in the age groups of 30-39 years (eyes open P=0.005; eyes closed P<0.001) and 40-49 years (eyes open P=0.002; eyes closed P=0.006). There was no significant difference between the age group of 30-39 years and the age group of 40-49 years (P=0.51). CONCLUSION: As for long-term following lumbar discectomy, there is no complete recovery of postural control. Patients seem to develop visual compensation mechanisms for underlying sensory-motor deficits, which are, however, sufficient in case of pain relief only. Further study is needed to determine the cause of the balance disturbances in lumbar discectomy patients.

Adult↗

PubMed2006

20 years follow-up after the first microsurgical lumbar discectomies in Iceland.

BACKGROUND: Microsurgical discectomies are an established procedure in spinal surgery. This operating technique was first used in the Department of Neurosurgery in Iceland in 1981 and has become standard operative treatment for herniated lumbar discs. There is a great variability in outcome reports regarding recurrence rate and re-operation rate. Few articles are based on follow-up of more than 10 years. This article presents the results of a 20 years follow-up study. METHODS: A retrospective study of all patients undergoing microsurgical discectomy for herniated lumbar disc, from June 1, 1981 to December 31, 1984. Outcome, based on recurrence rate, return to work and patient satisfaction was determined by a self-evaluation questionnaire, phone interviews and patient medical records. FINDINGS: Of the 170 patients, 134 (78.8%) were included in the study (M:F, 58:42%). Preoperative symptoms: back pain with sciatica 108 (80.6%), sciatica 20 (14.9%), back pain 2 (1.5%). Mean follow-up time was 20.7 years (19.5-22.8). Recurrence rate was 12.7%. 19 patients (14.2%) underwent a subsequent lumbar operation at a different level or side. A majority of patients 108 (80.6%) returned to previous level of work, 26 (19.4%) lost some or all working capabilities. Patient satisfaction was high, 91.1% reporting excellent (68.7%) or good (22.4%) results. 5.2% of patients rated the outcome fair and 3.7% poor. Women reported worse outcome than men, excellent M:F 74.7:60.7%, and poor 7.1:1.3%. There was no significant difference in patient satisfaction in patients undergoing additional operations or those with recurrence of the herniated disc. CONCLUSIONS: Outcome was very good with 92.0% return to work and 91.1% patient satisfaction. The recurrence rate was 12.7% with a substantial number of cases occurring 10-20 years after operation. To conclude, microsurgical discectomies maintain a high success rate in the long-term.

Adolescent↗

PubMed1998

Long-term outcome of patients who underwent percutaneous nucleotomy for lumbar disc herniation: results after a mean follow-up of 5 years.

A total of 41 patients who had undergone percutaneous nucleotomy for a single level lumbar disc herniation were clinically examined after a mean postoperative follow-up of 5 years (range 4 to 7 years). There were 14 (34%) male and 27 (66%) female patients with a mean age of 49 years. By intra-operative discography, the herniation had been graded as a protrusion in 21 (51%) patients and as a prolapse in 20 (49%) patients. At the time of the investigation, sciatica had completely recovered or markedly diminished in 32 (78%) patients, and 29 (71%) patients had returned to work. Evaluated by a 100 mm visual analog pain scale (VAS), the postoperative pain relief was statistically significant (p < 0.0001). Clinical signs and symptoms of segmental instability of the lumbar spine were detected in 10 (24%) patients. Instability was significantly associated with an unsatisfactory long-term outcome in the patients with the occurrence of sciatica (p = 0.003) and low back pain (p = 0.001) as well as the VAS score (p = 0.005) and Oswestry index (p < 0.0001). Clinical investigation revealed sensory deficits in the leg in 12 (29%) patients, weakness of the extensor hallucis longus muscle in 5 (12%) patients and a total peroneal paresis in one (2%). The patellar and achilles tendon reflexes were depressed in 2 (5%) and 5 (12%) patients, respectively. During the follow-up period, recurrent disc herniation was detected in 3 (7%) patients who were all re-operated on. In addition, 3 (7%) patients were re-operated on for other back problems. Corroborating earlier findings, the results of this study indicate that percutaneous nucleotomy is an effective and safe alternative to open surgery in the treatment of patients with a small prolapse or a protrusion.

Activities of Daily Living↗