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PubMed2006

Aneurysm of the common iliac artery presenting as a lumbosacral plexopathy.

We describe a case of lumbosacral plexopathy caused by an isolated aneurysm of the common iliac artery. The patient presented with worsening low back pain, progressive numbness and weakness of the right leg in the L2-L4 distribution. This had previously been diagnosed as sciatica. A CT scan showed an aneurysm of the right common iliac artery which measured 8 cm in diameter. Despite being listed for emergency endovascular stenting, the aneurysm ruptured and the patient died. It is important to distinguish a lumbosacral plexopathy from sciatica and to bear in mind its treatable causes which include aneurysms of the common and internal iliac arteries.

Aged↗

PubMed1997

Clinical and urodynamic characteristics of women with recurrent urinary incontinence after Burch colposuspension.

OBJECTIVE: The purpose of this study was to determine the clinical and urodynamic characteristics of women with recurrent urinary incontinence after Burch colposuspension. MATERIAL: Fifty women subjectively complaining of recurrent urinary incontinence (RUI) median 6 years after Burch colposuspension and 52 women with primary stress urinary incontinence were examined during 1991-93. METHODS: The participants were assessed with medical history, uro-gynecological examination and urodynamic investigation consisting of pad-test, urethrocystoscopy, cough provocation test, cystometry, urethra profilometry and flowmetry. RESULTS: Women with RUI demonstrated significantly increased incidences of recurrent lower urinary tract infection (24% vs. 8%), lumbago and sciatica (66% vs. 38%), rectocele (80% vs. 21%), and enterocele (24% vs. 0%) compared to women with primary stress urinary incontinence. Hypermobility of the bladder neck and urethra and palpable contraction of the levator ani muscles was observed significantly more often among the women with primary stress incontinence (90% vs. 42% and 83% vs. 56%, respectively). The leakage in women with RUI was significantly less pronounced than among women with primary stress incontinence. Detrusor instability was found significantly more often in women with RUI (47.51% vs. 23%). Low urethra pressure was found in five women with RUI. CONCLUSION: Women with RUI after Burch colposuspension seem to have a more pronounced pelvic floor weakness than women with primary stress urinary incontinence, whereas the urinary leakage is less pronounced. Recurrent lower urinary tract infection, lumbago and sciatica as well as detrusor instability are commonly observed whereas low urethral closure pressure is rare in women with RUI after Burch colposuspension.

Adult↗

PubMed1991

Prevalence of low back pain and other musculoskeletal symptoms and their association with work in Finnish reindeer herders.

The prevalence of musculoskeletal symptoms was determined in a population-based sample of 2720 male reindeer herders in Finland by postal questionnaires sent out in 1986 and 1988. Sixty per cent reported back pain, 32% sciatica, 51% neck-shoulder pain, and 49% pain, aching or tenderness in at least one joint during the past 12 months. The neck-shoulder and joint symptoms increased with the annual amount of reindeer herding work done in persons below 50 years of age. The association of back pain with the amount of work was weak, and no consistent association was found for sciatica. Neck-shoulder and joint symptoms were most frequently exacerbated by physically heavy work such as slaughtering the reindeer. It is suggested that self-reported neck-shoulder and joint symptoms are associated with reindeer herding, but that the association is partly biased due to selection of disease-prone older individuals for less demanding tasks.

Adolescent↗

PubMed1993

Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy.

Percutaneous endoscopic discectomy is a new technique for removing "contained" lumbar disc herniations (those in which the outer border of the anulus fibrosus is intact) and small "noncontained" lumbar disc herniations (those at the level of the disc space and occupying less than one-third of the sagittal diameter of the spinal canal) through a posterolateral approach with the aid of specially developed instruments. The technique combines rigid straight, angled, and flexible forceps with automated high-power suction shaver and cutter systems. Access can thus be gained to the dorsal parts of the intervertebral space where the disc herniation is located. Percutaneous endoscopic discectomy is monitored using an endoscope angled to 70 degrees coupled with a television and video unit and is performed with the patient under local anesthesia and an anesthesiologist available if needed. Its indication is restricted to discogenic root compression with a minor neurological deficit. Two groups of patients with contained or small noncontained disc herniations were treated by either percutaneous endoscopic discectomy (20 cases) or microdiscectomy (20 cases). Both groups were investigated in a prospective randomized study in order to compare the efficacy of the two methods. The disc herniations were located at L2-3 (one patient), L3-4 (two patients), or L4-5 (37 patients). There were no significant differences between the two groups concerning age and sex distribution, preoperative evolution of complaints, prior conservative therapy, patient's occupation, preoperative disability, and clinical symptomatology. Two years after percutaneous endoscopic discectomy, sciatica had disappeared in 80% (16 of 20 patients), low-back pain in 47% (nine of 19 patients), sensory deficits in 92.3% (12 of 13 patients), and motor deficits in the one patient affected. Two years after microdiscectomy, sciatica had disappeared in 65% (13 of 20 patients), low-back pain in 25% (five of 20 patients), sensory deficits in 68.8% (11 of 16 patients), and motor deficits in all patients so affected. Only 72.2% of the patients in the microdiscectomy group had returned to their previous occupation versus 95% in the percutaneous endoscopic discectomy group. Percutaneous endoscopic discectomy appears to offer an alternative to microdiscectomy for patients with "contained" and small subligamentous lumbar disc herniations.

Adolescent↗

PubMed1999

[Prognostic value of preoperative electromyography for outcome of lumbosacral radiculopathy of discal origin].

OBJECTIVES: To assess the prognostic value of preoperative electromyography (EMG) for long-term outcome in patients who undergo surgery for discal radiculalgia at the lumbar level. PATIENTS AND METHODS: Thirty-seven patients who underwent surgery less than 6 weeks after the EMG were selected among a pool of 384 patients suffering from discal radiculalgia at the lumbar level who had had an EMG at our hospital since 1980. Among these 37 patients, 30 were contacted by telephone for an interview on outcome after a mean 42.1 +/- 22 month follow-up. RESULTS: Five out of 30 patients reported limitation for walking, 8/30 motor weakness, 14/30 had sensorial deficits, 12/30 had frequent or incapacitating radiculalgia, and 16/30 reported paresthesia. Patients were more satisfied with pain outcome (good or very good results in 22/30 patients (73%)) than with functional outcome (good or very good results in 20/30 patients (66%)). Preoperative EMG abnormalities (observed in 22/30 cases) were not correlated with patient age or duration of sciatica. The patients whose preoperative EMG was abnormal did not later report more paresthesia (11/20 versus 5/10) or severe radiculalgia (7/20 versus 5/10) than the others. Conversely, they complained more frequently of motor weakness (7/20 versus 1/10), but their global opinion about long-term outcome of surgery was not worse good or very good results for 15/20 patients with abnormal EMG (75%) versus 7/10 (70%) of those whose preoperative EMG was normal. CONCLUSION: This study shows that a normal EMG does not preclude surgical cure of discal sciatica. The results of preoperative EMG do not predict the long-term outcome after surgery: indeed they are only correlated with motor weakness (7/20 versus 1/10), but not with residual pain and functional outcome.

Adult↗

PubMed1977

[Disk curettage in inveterate lumbago. Recent results in 45 cases].

Forty-five cases of intractable discogenic low back pain without sciatica were treated by curettage of the disc without grafting. One disc was curetted in 23 cases, two disc in 22 cases. The results are very good in 23 cases, good in 19 cases, and poor in 3 cases. The post-operative follow-up is between 1 and 2 years in 19 cases, 2 and 5 years in 13 cases, and more than 5 years in 13 cases. The length of follow-up and the number of discs curetted bear no relation to the quality of the result. In 8 cases a typical disc protrusion was found. In all other cases the appearance was different from that seen in the surgery of sciatica. Degeneration of the disc was a constant finding and presented various manifestations: simple protrusion, thickening of the posterior vertebral ligament, abnormal compressibility, and even an apparently normal disc, in which degeneration was only demonstrable after incision of the disc. Surgical exploration confirmed in early every case the data from discography. Radiodynamic examination after the operation showed a diminution in the mobility of the curetted disc, but perfect anatomical fusion is not necessary in order to obtain good results. The authors stress the necessity for great care in the selection of patients and in the operative technique.

Adult↗

PubMed2003

The role of caudal epidural injections in the management of low back pain.

The value of caudal epidural steroid injections (CEI) in treatment of low back pain and sciatica is controversial. It is believed that CEI are mainly effective in treating acute radiculopathy at intermediate term follow up and have no long-term benefit. The objective of this study was to evaluate the role of CEI in the management of low back pain. This study reviews all patients with low back pain and sciatica treated with CEI in a one-year period (1997) in the orthopaedic department at Aberdeen. The case notes of 163 out of a possible 175 patients (87 female 76 male) with mean age of 51 years (range: 17 to 88 years) were reviewed. Data collected included primary symptoms, presentation time, presumed diagnosis, MRI diagnosis, grade of the surgeon ordering and performing the procedure, the quality and duration of response, and final outcome. Patients were regarded as having an Excellent response if they had good or excellent pain relief for more than 3 months, a Good response (6 weeks to 3 months), Fair (4 to 6 weeks), Brief (any pain relief for less than 4 weeks), and No relief. Forty-one percent of patients had either an excellent/good response to CEI while 34% were no better or worse. Patients presenting acutely or with predominantly leg pain symptoms did not respond any better to the CEI than chronic presentations or low back pain alone. Only 36 of 73 patients who were discharged had an Excellent/Good response. Therefore the response to CEI did not influence the decision to discharge half of the patients. The experience of the surgeon performing the procedure did not make a difference in the outcome. We found that the outcome of CEI was unpredictable. The clinical value of CEI remains unproven. The decision to perform the procedure may well remain a matter of personal choice and experience.

Adolescent↗

PubMedDate not supplied

[Lumbar spinal surgery in elderly patients].

INTRODUCTION: In the geriatric population, pain with sciatic irradiation requires a differential diagnosis to enable a distinction to be made mainly between a herniated disc, lateral recess stenosis or lumbar stenosis. In addition, in many cases the degenerative problems are often associated with lumbar listhesis or instability. Furthermore, these patients present very diverse associated cardiovascular, pulmonary or metabolic pathologies which can make surgery complicated and, above all, prolong post-operative recovery, as well as increasing morbidity and mortality. PATIENTS AND METHODS: We reviewed a group of 50 patients aged between 70 and 87 who had been submitted to surgery between 1997 and 2003; 27 were females and 23 males. 76% of them presented associated systemic pathologies and 22% had a history of previous spinal surgery. In 15 cases clinical symptoms were gait disorders involving claudication, there were three cases of paraparesis with cauda equina syndrome, 19 lumbagos with bilateral sciatica and 16 cases of lumbago with unilateral sciatica. Unilateral decompression hemilaminectomy was performed in 16 patients (group I) with microdiscectomy in 13 cases, laminectomy of one or several vertebrae (group II) was carried out in 17 patients and another 17 patients were submitted to decompression laminectomy plus arthrodesis with transpedicular instrumentation (group III). RESULTS: Overall a significant improvement was observed in 86% of patients. Detected complications involved two serious deep infections (4%), one of which was secondary to cerebrospinal fluid fistula, and the other occurred in an instrumented patient. No instabilities secondary to the laminectomy were observed in non-instrumented patients. No intraoperative anaesthetic or surgical complications were produced. Patients are followed up simultaneously during the post-operative period by both Internal Medicine and Neurosurgery. CONCLUSIONS: In the geriatric population there is a high incidence of degenerative problems, not only involving canal stenosis but also herniated discs. Surgical intervention must be the least aggressive possible, bearing in mind that a laminectomy does not presuppose post-surgical stability. The associated pathologies presented by these patients make a good immediate post-operative follow-up indispensable if morbidity and mortality rates are to be reduced.

Aged↗

PubMed2005

[Related factors with the failed surgery of herniated lumbar disc].

INTRODUCTION: The surgery for herniated disc is the most common operation at the level of the lumbar spine. The failed surgery rates range between 10% and 40%, conforming what is known as Failed Back Surgery Syndrome (FBSS). Return to work after surgery occurs in 70-85% of the cases. There are a few studies analysing the quality of life after the operation. The aims of this study are to know the incidence of the herniated disc lumbar failed surgery in our area, identify those factors influencing its development, and study behavioural parameters as the return to work and the quality of life at a middle term after surgery, also its relation with the success or failure surgery. MATERIAL AND METHODS: A descriptive transversal study of 117 patients operated for herniated lumbar disc during the first six months of the year 2003 is reported. In order to evaluate the incidence of failed surgery and the related factors, the clinical records were retrospectively analyzed. Ninety one patients were interviewed by phone using the Health Questionnaire SF-36, in order to analyze the non clinical factors related to FBSS, such as labour reincorporation, satisfaction with surgery, realization of rehabilitation treatment and quality of life after surgery. For the statistical analysis of the results, we used the program SPSS 11.01. RESULTS: In a sample in which the proportion between both sexes was 1/1, and the middle age was over 45 years [35-54], in which the most frequent clinical symptom was right sciatica, lasting more than 6 months, correlated to disc herniation at L5-S1 level, 37.9% of the patients presented FBSS. Although there were a few patients with reoperation in our study, the incidence of FBSS in these patients was higher (52.9%) than in patients who suffered this surgery for first time (32%). The predictive clinical factors of an unfavourable result in patients operated on for first time were bilateral sciatica, the presence of stenosis associated to herniated disc and comorbidity factors. On the other hand the sociolabor factors identified were a low culture level and those working as drivers, building and service sectors. Return to work occurred in the 64% of the active workers before surgery. Only around 10% of patients were dissatisfied with surgical result and there was a significant relationship between this and the physical function, pain, vitality and emotional status in the SF-36 with the FBSS. CONCLUSIONS: One out of three patients operated of herniated lumbar disc in our area presented failed disc surgery and the return to work occurred in 2 out of three patients active before the operation. The failed surgery patient suffers from pain, that interferes and limits the labour and home activities. Furthermore, the patient presents frequent sensation of fatigue and exhaustion and also emotional problems that contribute to interfere with work and activities of the daily life.

Adult↗

PubMed1989

[Synovial cysts and synovialomas of the lumbar spine. Histo-pathologic and neuro-surgical aspects apropos of 8 cases].

Based on 8 personal cases and a 81-cases review of literature, it's authors' opinion that cystic or solid masses issued form posterior lumbar articular process and called according to the cases synovial cyst, ganglion cyst, benign synovialoma, pigmented villonodular synovitis, are a single variety of benign degeneration of soft articular tissues. The cystic or solid feature of these masses depends upon the extent of their histiocytic granulomatous proliferation. They may be asymptomatic, accompany chronic lumbar pain or cause sciatica, seldom cauda equina syndrome. In case of sciatica, clinical picture rather consists of a narrow lateral recess than a discal protrusion. CT scan is the best investigation to get a right preoperative diagnosis. Postoperative prognosis is excellent and no anatomical recurrence has been reported.

Adult↗

PubMed1989

Does percutaneous nucleotomy with discoscopy replace conventional discectomy? Eight years of experience and results in treatment of herniated lumbar disc.

Percutaneous nucleotomy was first described in 1975 by Hijikata in Japan. In 1979 the present authors adopted this method for the treatment of lumbar disc herniation and modified Hijikata's original instruments. Since 1982 additional intradiscal optical control has been included by means of an adapted arthroscopic kit for more accurate and effective removal of the nucleus pulposus under direct view. This procedure is called discoscopy. Between 1979 and late 1987, the method was applied to 109 patients with lumbar disc herniation. The indications included lumbar sciatica that (1) was resistant to conservative treatment and (2) in which myelography and/or examination by computed tomography proved a disc protrusion without dislocation in the spinal canal. The level most affected was L4-L5. Major operative complications encountered were one vascular lesion and two cases of secondary spondylodiscitis. Clinical results in patients with other additional causes of sciatica, such as spondylolisthesis or relapse of disc herniation, were nearly as favorable as in isolated first-time disc herniation. The overall success rate was 72.5% (79/109 patients).

Adult↗

PubMed1977

Communicating with the rheumatic patient.

To explore the meanings attached to words by patients and doctors, a multiple-choice questionnaire was given to 214 rheumatic patients, 110 non-rheumatic patients, 227 rheumatologists and 36 general practitioners. Words and phrases dealt with symptoms in descriptive terms, common disorders and parts of the body relevant to rheumatology. Poor agreement was obtained for 'back' among rheumatologists and hospital doctors, and for 'arthritis' among general practitioners. The word 'sciatica' means very different things to different doctors. Among rheumatic sufferers good agreement was only reached for 'rheumatism' and 'hereditary'. Non-rheumatic sufferers obtained better agreement than the rheumatic patients. This may have been due to more in the professional classes among the former group. The poorest agreement among rheumatic patients was for 'numbness', 'sciatica', 'slipped disc', 'vertebra', 'cervical', 'spinal cord', 'arthritis', 'deformity', 'anaemia', 'ligaments', 'osteoarthritis', 'lumbar', 'sacrum' and 'back'. Poor doctor-patient correlation between patients and rheumatologists occurred for 'numbness', 'spinal cord', 'cervical', 'sacrum', 'loin', 'slipped disc', 'arthritis', 'osteoarthritis' and 'steroids'.

Adult↗

PubMedDate not supplied

Cauda equina syndrome presenting as a herniated lumbar disk.

Cauda Equina Compression (CEC) is a clinical syndrome consisting of low back pain, bilateral sciatica, saddle anesthesia, bilateral lower extremity weakness, and even frank paraplegia with bowel and bladder incontinence. At the onset of CEC, the clinical picture may resemble typical intervertebral disk disease with low back pain and unilateral sciatica. The back pain is severe, overshadowing the leg pain, and should alert the physician to the periodic evaluation of the patient and evidence of a progressive neurologic deficit. Early discovery of CEC is necessary if neurologic recovery is to be expected from decompressive laminectomy.

Aged↗

PubMed1995

Results of epidural injection of local anaesthetic and corticosteroid in patients with lumbosciatic pain.

Epidural steroid therapy is one of the useful conservative modalities of treatment of low back pain with sciatica. Epidural injection of a mixture of 80 mg (2 ml) of methylprednisolone, 25 ml of normal saline and 10 ml of 2% lignocaine hydrochloride through sacral route produced excellent to good results in 83% of patients of low back pain with sciatica with subacute symptoms of less than 3 months duration, when evaluated after 3 months of injection. When evaluated after one year of injection the success rate came down to 64.8%.

Adult↗

PubMed1995

Assessment and exercise in low back pain. With special reference to the management of pain and disability following first time lumbar disc surgery.

Eight articles including 555 low back pain patients have been published. They included the following topics: 1) A ratio interval rating scale (Low Back Pain Rating Scale (RS)) was introduced. The possibility of registering the actual status in low back pain patients including; Back Pain, Sciatica, Functional Disability and Physical Impairment was studied. Methods of evaluating index-scales developed in the field of psychometry were applied in the validation process of RS. RS was found to be both valid and user friendly. 2) Using Low Back Pain Rating Scale the general outcome following first-time lumbar disc surgery was analysed through a survey. The results showed that more than half of the patients still suffered from considerable Back Pain, Sciatica, and Functional Disabilities. Approximately 25% of the patients risked reduced work capabilities, and many receive pensions. 3) By means of a comprehensive statistical analysis of 18 studied preoperative demographic and physical findings, sex, hypoalgesia, smoking and Finneson-index were found to have prognostic value. 4) Attempts at influencing the results obtained from lumbar disc surgery have been tested in 3 randomized trials, including back training and peroperative glucocorticoid administration. 5) Three randomized trials including patients suffering from chronic low back pain (with or without previous lumbar disc surgery) attempted to convey which elements of a training programme provide patients with the greatest effect and the least risk of side-effects. It was concluded that Low Back Pain Rating Scale is a useable assessment instrument in both clinical trials and as a daily quality control instrument of back patients. There is a need of increased patient scrutiny in patient selection prior to lumbar disc surgery. Postoperative rehabilitation should include intensive back training, which has been shown to be of value in behavioural support and restoration of functional deficits. This has resulted in increased work capacities for disc operated patients. The exercise programmes are generally free of side-effects. As regards chronic back pain patients with or without previous lumbar surgery, high dosage exercises with training periods lasting at least 12 to 16 sessions are of crucial importance for success. Exercises should be dynamic and full-range, and carried out following the adage "Don't let the pain be your guide.

Exercise Therapy↗

PubMed1995

[Imaging of the lumbar spine after diskectomy].

The radiological investigation of persistent or recurrent sciatica after lumbar diskectomy essentially consists of demonstrating recurrent disk herniation. Comparison between plain and contrast enhanced CT or MR examinations at the level of the diskectomy is the main step of the radiological survey. The meanings of the various radiological findings are discussed. Other lesions that may induce persistent sciatica after lumbar diskectomy include degenerative narrowing of the lateral recess, spinal instability, stress fracture of the remaining neural arch, pseudo-meningomyelocele after laminectomy.

Diskectomy↗

PubMedDate not supplied

Complications associated with epidural steroid injections.

BACKGROUND AND OBJECTIVES: Warnings about the hazards of epidural steroid injections occasionally appear in both medical and lay literature despite a lack of objective data to support such concerns. This literature review was undertaken to survey reports of adverse reactions associated with that procedure. METHODS: The following types of publications from peer-reviewed medical literature was surveyed: reports on series of epidural and subarachnoid steroid injections for sciatica; reports of adverse effects of epidural and subarachnoid steroid injections for sciatica; review articles on epidural and subarachnoid steroid injections; and studies of the behavioral and histologic effects of epidural steroids and their vehicle in animals. RESULTS: Several cases of aseptic meningitis, arachnoiditis, and bacterial meningitis and one case of conus medullaris syndrome have been reported after subarachnoid steroid injections. Most of these complications occurred after multiple subarachnoid injections. Two cases of epidural abscess, one case of bacterial meningitis, and one case of aseptic meningitis have been reported following epidural steroid injections. Subarachnoid drug placement could not be ruled out in the meningitis cases. CONCLUSIONS: There are few published reports of serious complications following epidural steroid injections. There are a few published reports of complications following subarachnoid steroid injections, most of which were associated with multiple injections over a prolonged time period.

Animals↗

PubMed1997

Mechanisms of low back pain: a neurophysiologic and neuroanatomic study.

Idiopathic low back pain has confounded health care practitioners for decades. The cellular and neural mechanisms that lead to facet pain, discogenic pain, and sciatica are not well understood. To help elucidate these mechanisms, anesthetized New Zealand white rabbits were used in a series of neurophysiologic and neuroanatomic studies. These studies showed the following evidence in support of facet pain: an extensive distribution of small nerve fibers and endings in the lumbar facet joint, nerves containing substance P, high threshold mechanoreceptors in the facet joint capsule, and sensitization and excitation of nerves in facet joint and surrounding muscle when the nerves were exposed to inflammatory or algesic chemicals. Evidence for pain of disc origin included an extensive distribution of small nerve fibers and free nerve endings in the superficial annulus of the disc and small fibers and free nerve endings in adjacent longitudinal ligaments. Possible mechanisms of sciatica included vigorous and long lasting excitatory discharges when dorsal root ganglia were subjected to moderate pressure, excitation of dorsal root fibers when the ganglia were exposed to autologous nucleus pulposus, and excitation and loss of nerve function in nerve roots exposed to phospholipase A2.

Animals↗