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At least 19 recordsLinked to original sources
PubMed2026

No Efficacy of Dexamethasone Injections for Acute Sciatica: A Double-Blind Randomized Study Versus Saline.

BACKGROUND: The efficacy of caudal injections for patients with acute sciatica remains controversial. The DEXHIA study was designed to evaluate whether ultrasound-guided caudal injection of dexamethasone provides superior clinical outcomes compared with saline placebo. METHODS: This prospective, randomized, placebo-controlled, double-blind trial included adult patients with sciatica secondary to lumbar disc herniation of less than 3 months' duration. Participants were randomly assigned in a 1:1 ratio to receive either 16 mg of dexamethasone (4 mL) diluted with 16 mL of saline (DEXA group) or 20 mL of saline alone (PLACEBO group), administered by ultrasound-guided caudal epidural injection. The primary outcome was the change in the Oswestry Disability Index (ODI) at 3 weeks. Secondary outcomes included leg pain and low back pain assessed by visual analogue scale (VAS), health-related quality of life (SF-36), need for repeat epidural injection, and need for lumbar surgery. Clinical assessments were performed at 3 weeks, 3 months, and 6 months. RESULTS: A total of 106 patients were randomized, with 53 participants assigned to each treatment group. The primary endpoint was not met, as the improvement in ODI at 3 weeks did not differ significantly between groups (mean change: -9.5 ± 4.4 in the DEXA group versus -13.8 ± 4.4 in the PLACEBO group; p = 0.18). No significant differences were observed for any relevant secondary outcome at any follow-up time point. During the 6-month follow-up, 34 patients in the DEXA group and 30 patients in the PLACEBO group underwent a second, non-blinded injection of dexamethasone (ns). Lumbar surgery was performed in 10 patients in the DEXA group and nine patients in the PLACEBO group (ns). Injection-related adverse events were mild and transient but occurred more frequently in the DEXA group. CONCLUSIONS: Caudal injection of soluble dexamethasone conferred no clinical benefit over saline placebo in patients with acute sciatica. SIGNIFICANCE STATEMENT: Epidural injections are widely used worldwide for the treatment of resistant sciatica and have been extensively studied in multiple meta-analyses. However, their clinical value remains debated due to the limited methodological quality of most available studies. We conducted a methodologically rigorous randomized, placebo-controlled trial, which yielded negative results. These findings question the efficacy of caudal epidural injection of a non-particulate corticosteroid administered via a remote (sacrococcygeal) approach for disc-related sciatica. TRIAL REGISTRATION: The trial was registered under European Clinical Trials No. 2021-001571-17 and ClinicalTrials.gov identifier NCT05000658.

Adult↗
PubMedDate not supplied

[Arthrotic sciatica caused by radicular compression of osteophytic origin in the lateral recess. Apropos of 18 cases].

The authors report 18 cases of arthrosic sciatica due to toot compression in the lateral recess by posterior corporeal and/or posterior apophyseal osteophytosis. The authors study the clinical and radiological characteristics that may indicate the diagnosis and discuss the different mechanisms by which vertebral arthrosis can lead to radicular compression. When surgery is necessary because of the persistent nature of the sciatica, a broader approach should be undertaken than that required for excision of the disc, in order to explore fully the roots, the multiplicity of possible compression sites being one of the essential characteristics of these cases of arthrosic radiculopathy. Study of the literature and of the series of sciatica patients operated upon by the authors shows that although discal hernia is far from being the most frequent cause of common sciatica, arthrosic compression is a cause that cannot be ignored, especially in aged subjects.

Female↗
PubMed1979

[Usefulness of questionnaires in detection of early symptoms of sciatica and related pain syndromes of the lumbosacral region and determination of their incidence among workers of textile industry].

The study was aimed at the determination of sciatica case rate among cotton industry workers based on inquiry. Two questionnaires for detecting complaints typical of sciatica were developed. 2463 weavers and 3083 spinners were examined. A comparative group involved 978 shop attendants and 593 office workers. It was found out that pains characteristic of sciatica were experienced by 45% weavers, 43% shop attendants, 29.2% spinners, and 16% office workers. Results of physical examinations in randomly selected cases corresponded in 97% with the questionnaire data. In most cases pains resulted from overloading of the lower section of the vertebral column.

Back Pain↗
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↗
PubMedDate not supplied

Epidemiologic and clinical studies of long-term prognosis of low-back pain and sciatica.

In order to justify the selection of therapeutic measures for low-back pain and sciatica, epidemiologic and clinical studies were performed of the natural histories or the long-term prognosis of those symptoms. The main conclusions drawn in relation to decision making are as follows: low-back pain is more frequent than sciatica or intermittent claudication, but the latter is more disabling; acute attacks are generally more disabling than chronic pain, and the frequency may be more closely related to poor prognosis than the duration; radiologic findings are of little value in differentiating the incidence and degree of the symptoms during life; myelographic or peridurographic abnormalities do not always suggest poor prognosis.

Acute Disease↗
PubMed1977

[Sciatica caused by massive herniated disk].

On the basis of the surgical findings in 10 cases a description is given of a massive form of disc hernia corresponding to posterolateral displacement of the entire disc with the fibrous ring and cartilaginous surfaces. Such hernias were found in 7 cases of severe lumbar sciatica, including 3 with the cauda equina hemisyndrome and in 3 cases of simple lumbar sciatica operated on for their severe and refractory nature. It is useful to know this variety of hernia so that its uncommon aspect is not surprising on surgery. The term of massive hernia is proposed exclusively for these forms.

Adult↗
PubMed1977

[Classical low back pain and sciatica syndrome caused by a melanotic nerv sheath tumour of the first sacral root (author's transl)].

This is the description of the case of a 22 year old patient with low back pain and sciatica on the right side investigated by lumbar Dimer-X-Myelography. The result of the examination was an impression in the contrast column at the L5/S 1 level on the right. At operation an intradural tumour, plum-sized, well-defined, and blue-black in colour, was found and removed. Histologically the tumour was melanotic and of high cellular density, with spindle-shaped cells as well as giant cells, with round nuclei, considerable polymorphism, and atypical mitoses. On the basis of the operation finding, the clinical course, and the histology, the diagnosis is melanotic nerve sheath tumour of the first sacral root. For two years following operation the patient has experienced no discomfort.

Adult↗
PubMedDate not supplied

Knee flexion test and sciatica.

Knee flexion of the leg when a patient with sciatica bends to reach the floor is objective evidence of lumbar spinal nerve root compression. Contralateral sciatic scoliotic list usually accompanies the finding, which should be known as a positive knee flexion test for sciatic spinal nerve root compression.

Humans↗
PubMed1977

Spinal nerve block. A diagnostic test in sciatica.

The cause of sciatica has been studied by blocking spinal nerves of the lumbosacral plexus in intervertebral foramina. The nerve, which is singled out with the aid of an image intensifier, is injected with 1 ml of 1 per cent Xylocain. If the Xylocain injection eliminates the sciatic pain, the surgeon may be confident that a true nerve-root compression is involved, and he can then explore as far as he finds necessary. The correlation between the site of compression and the level indicated by the test was confirmed by operation in 19 patients.

Adult↗
PubMedDate not supplied

Phenylbutazone in treatment of acute lumbago-sciatica.

In a double-bind investigation of the effect phenylbutazone (initially injected + Butazolidin Alka p.o.) was compared with that of placebo in 36 patients with acute lumbago-sciatica without root involvement in the form of paresis. The investigation showed that the effect of phenylbutazone was significantly better than that of placebo. The side-effects of the drug were mild.

Acute Disease↗
PubMed1976

Chemonucleolysis: a double blind study comparing chemonucleolysis with intra discal hydrocortisone: in the treatment of backache and sciatica.

This paper attempts to answer the controversial question, namely, how effective is chemonucleolysis in the treatment of discogenic back pain and sciatica? By using a type of double-blind study, a comparison has been made between 20 patients who were treated with chemonucleolysis and 20 who were treated with intra-discal hydrocortisone. The 2 year post-injection survey by an independent observer, demonstrated that chemonucleolysis produced 9 good, 3 fair, and 8 unimproved results in 20 patients. In contrast, hydrocortisone produced 3 good, 8 fair, and 8 unimproved results in 20 patients - one patient dying from unrelated causes. Although not statistically significant, the data suggest that chemonucleolysis was superior to intra-discal hydrocortisone in this series.

Adult↗
PubMedDate not supplied

[Injection of the sacrolumbar roots: a complementary method of staging sciatica. 18 cases].

The injection of the sacrolumbar roots allows, in the first place, the root to be made opaque in order to determine its morphology and, in the second place and above all, causes the disappearance of the radicular pain after injection of a local anesthetic, which helps the degree of sciatica to be identified. This method, which should be limited to exceptional cases, seems to be useful in patients who have undergone lumbar surgery and for whom the interpretation of contrast x-ray exams poses a particularly delicate problem. It can also be advisable when these exams are not conclusive or when the results do not coincide with the clinical data. Since March, 1974, 18 patients have undergone this exam. In 14 cases the disappearance of the radicular syndrome, after injection of xylocain close to the root, has allowed the root in question to be identified. In 3 cases radicular injection has practically made it possible to rule out an organic lesion. This exam had no side effect and was always tolerated even by two patients allergic to iodine.

Adult↗
PubMed1976

Cyclic sciatica of endometriosis. Case report.

A 27-year-old woman with right-sided cyclic sciatica and stiffness of the right hip joint, unresponsive to orthopaedic measures, is presented. An exploratory laparotomy revealed pelvic endometriosis. On oestrogen suppression therapy, she has been symptom-free for eleven months.

Adult↗
PubMed1977

Short term prognosis in sciatica. A prospective study of factors influencing the results with special reference to myelography.

334 Types of follow-up data were collected in 158 patients with sciatica. The following information was obtained: (a) in L4-L5 herniations, Achilles tendon reflex disturbance was not explained by S1 root compression, as visualized at this level on myelography, (b) a water-soluble myelogram was also reliable for extreme lateral herniations and only those herniations dislocated into the intervertebral root canal remained undiagnosed, (c) a positive neurological or myelographic diagnosis of herniation did not mean a better short-term prognosis. Operative removal of a large herniated mass gave the best chance of good recovery. The main indication for myelography is a guide to the surgeon for the correct operative level.

Adolescent↗