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Search Results for : Sciatica
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Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
The impact of workers' compensation on outcomes of surgical and nonoperative therapy for patients with a lumbar disc herniation: SPORT.
Author(s): Atlas, SJ; Tosteson, TD; Blood, EA; Skinner, JS; Pransky, GS; Weinstein, JN
Journal: Spine (Phila Pa 1976) 2010 Mar 3; Vol. 35, Issue 1; Page(s) 89-97
[Medline ID - 20023603]

STUDY DESIGN: Prospective randomized and observational cohorts. OBJECTIVE: To compare outcomes of patients with and without workers' compensation who had surgical and nonoperative treatment for a lumbar intervertebral disc herniation (IDH). SUMMARY OF BACKGROUND DATA: Few studies have examined the association between worker's compensation and outcomes of surgical and nonoperative treatment. METHODS: Patients with at least 6 weeks of sciatica and a lumbar IDH were enrolled in either a randomized trial or observational cohort at 13 US spine centers. Patients were categorized as workers' compensation or nonworkers' compensation based on baseline disability compensation and work status. Treatment was usual nonoperative care or surgical discectomy. Outcomes included pain, functional impairment, satisfaction and work/disability status at 6 weeks, 3, 6, 12, and 24 months. RESULTS: Combining randomized and observational cohorts, 113 patients with workers' compensation and 811 patients without were followed for 2 years. There were significant improvements in pain, function, and satisfaction with both surgical and nonoperative treatment in both groups. In the nonworkers' compensation group, there was a clinically and statistically significant advantage for surgery at 3 months that remained significant at 2 years. However, in the workers' compensation group, the benefit of surgery diminished with time; at 2 years no significant advantage was seen for surgery in any outcome (treatment difference for SF-36 bodily pain [-5.9; 95% CI: -16.7-4.9] and physical function [5.0; 95% CI: -4.9-15]). Surgical treatment was not associated with better work or disability outcomes in either group. CONCLUSION: Patients with a lumbar IDH improved substantially with both surgical and nonoperative treatment. However, there was no added benefit associated with surgical treatment for patients with workers' compensation at 2 years while those in the nonworkers' compensation group had significantly greater improvement with surgical treatment.

Extraspinal sciatica revealing late metastatic disease from parotid carcinoma.
Author(s): Le Manac'h, AP; Rousselet, MC; Massin, P; Audran, M; Levasseur, R
Journal: Joint Bone Spine 2010 May 5; Vol. 77, Issue 1; Page(s) 64-6
[Medline ID - 20022535]

Sciatica is a clinical symptom usually caused by a disk herniation and less often by other conditions such as tumors, infections, or inflammatory diseases. We report the case of a woman in whom sciatica led to the identification of a large pelvic metastasis from a carcinoma of the parotid gland.

An anti-nociceptive role for ceftriaxone in chronic neuropathic pain in rats.
Author(s): Hu, Y; Li, W; Lu, L; Cai, J; Xian, X; Zhang, M; Li, Q; Li, L
Journal: Pain 2010 Apr 15; Vol. 148, Issue 2; Page(s) 284-301
[Medline ID - 20022427]

Glial glutamate transporter-1 (GLT-1) plays an essential role in the maintenance of glutamate homeostasis and is involved in the development and maintenance of pathological pain. The present study was undertaken (1) to observe the anti-nociceptive effects of ceftriaxone (Cef) in a chronic neuropathic pain model induced by chronic constrictive nerve injury (CCI) of the sciatic nerve and (2) to identify the role of spinal GLT-1 in the process. CCI induced significant thermal hyperalgesia and mechanical allodynia, which began from postoperative day 3 and lasted to day 21. This long-term hyperalgesia was accompanied by significant down-regulation of GLT-1 expression in the L4-L6 segments of the spinal dorsal horn, as revealed by immunohistochemistry and Western blot. Intraperitoneal preventive and therapeutic administration of Cef effectively prevented or reversed, respectively, the development of thermal hyperalgesia, mechanical allodynia, and GLT-1 down-regulation in the spinal dorsal horn. To further determine whether the above anti-nociceptive effects of Cef are a result of the up-regulation of spinal GLT-1 expression and its function, we further observed the effects of intrathecal administration of Cef in the same model. It was found that intrathecal administration of Cef led to the specific up-regulation of GLT-1 expression and glutamate uptake ((3)H-glutamate) in the spinal dorsal horn, and similar anti-nociceptive effects to those of intraperitoneal administration of Cef. The above effects of intrathecal Cef administration were all significantly inhibited by intrathecal administration of GLT-1 antisense oligodeoxynucleotides (As-ODNs). These results indicate that Cef plays an anti-nociceptive role by up-regulating spinal GLT-1 expression and its function.

Painful legs and moving toes following a traumatic medial plantar nerve injury.
Author(s): Zinnuroglu, M; Ozkayran, T
Journal: Mov Disord 2010 Apr 7; Vol. 25, Issue 1; Page(s) 133-5
[Medline ID - 20014060]

ABSTRACT NOT AVAILABLE

Piriformis syndrome: a real pain in the buttock?
Author(s): Halpin, RJ; Ganju, A
Journal: Neurosurgery 2010 Mar 17; Vol. 65, Issue 4 Suppl; Page(s) A197-202
[Medline ID - 19927068]

OBJECTIVE: Herein, we provide an unbiased review of piriformis syndrome (PS), a highly controversial syndrome for which no consensus exists regarding diagnostic criteria or pathophysiology. METHODS: A review of the literature in the English language. RESULTS: A nonpartisan review of the medical literature pertaining to PS revealed that the existence of this entity remains controversial. There is no definitive proof of its existence despite reported series with large numbers of patients. CONCLUSION: PS remains a controversial diagnosis for sciatic pain. The debate regarding the clinical significance of PS remains active. Nonetheless, there may be a subset of patients in whom the piriformis muscle is a source of pain. The syndrome should be considered in the differential diagnosis of patients with unilateral lower extremity pain.

Inferior gluteal vein varicosities: a rare cause of sciatica.
Author(s): Choudur, HN; Joshi, R; Munk, PL
Journal: J Clin Rheumatol 2010 Mar 20; Vol. 15, Issue 8; Page(s) 387-8
[Medline ID - 19955994]

A 77-year-old woman presented with gradually progressing right sciatica of 2 years duration. She was investigated with a magnetic resonance imaging of the lumbosacral spine which did not reveal any abnormality. Magnetic resonance imaging of the pelvis was then performed and revealed right inferior gluteal vein varicosities causing compression of the adjacent sciatic nerve resulting in sciatica. Pain was relieved by walking likely due to collapse of the vein. This patient declined surgery but benefit has been reported in similar cases.

Risk factors for lumbar intervertebral disc herniation in Chinese population: a case-control study.
Author(s): Zhang, YG; Sun, Z; Zhang, Z; Liu, J; Guo, X
Journal: Spine (Phila Pa 1976) 2010 Feb 25; Vol. 34, Issue 25; Page(s) E918-22
[Medline ID - 19940721]

STUDY DESIGN: A case-control study of 4180 subjects was carried. OBJECTIVE: To explore the risk factors of lumbar disc herniation in China. SUMMARY OF BACKGROUND DATA: In China, along with the economic development, people's living environment and working conditions have undergone some tremendous changes, such as the accelerating life pace and competition. In this situation, it is important to know whether the risk factors of lumbar disc herniation have changed or not. This case-control study, including the possible social and psychological factors based on the literature, attempted to search the new risk factor, therefore provide better prevention measures for lumbar disc herniation. METHODS: A total of 2010 hospitalized patients, diagnosed with lumbar disc protrusion by CT and/or MRI were selected as cases. A total of 2070 people from communities and hospitals, without history of low back pain and sciatica, were selected as controls. All patients and controls were investigated for their family history, occupational characters' smoking status, working psychosocial factors, etc. The risk factors were analyzed by multiple nonconditional logistic regression method. RESULTS: Family history (OR = 3.6) was the most important risk factor for lumbar disc protrusion in this study, followed by lumbar load (OR = 2.1), hard-working (OR = 1.8), and time urgency (OR = 1.1). Additionally, physical exercises (OR = 0.5) and bed characteristics (OR = 0.4) appeared to be the protective factors for lumbar disc protrusion. After stratified by age, family history (OR = 14.5), occupational character (OR = 5.2), and physical exercises (OR = 0.2) stronger association with lumbar disc protrusion was seen in subjects younger than 30 years. In subjects from 30 to 55 years, family history (OR = 5.1), lumbar load (OR = 1.91), hard-working (1.9), physical exercises (OR = 0.5), time urgency (OR = 1. 3), bed characteristics (OR = 0.4) were significantly important. In subjects older than 55 years, lumbar load (OR = 2.9) and bed characteristics (OR = 0.4) were closely related to lumbar disc protrusion. CONCLUSION: Family history, lumbar load, hard-working, and time urgency are the major risk factors for lumbar disc herniation, and physical exercises and sleeping on the hard bed might be the protective factors.

Occupational sciatica.
Author(s): Sanborn, TA
Journal: Catheter Cardiovasc Interv 2010 Apr 2; Vol. 75, Issue 2; Page(s) 303-4
[Medline ID - 19937783]

ABSTRACT NOT AVAILABLE

Microsurgical decompression of degenerative lumbar spinal stenosis.
Author(s): Mayer, HM; Korge, A
Journal: Eur Spine J 2010 Jul 9; Vol. 18, Issue 12; Page(s) 1989-1990
[Medline ID - 19937063]

ABSTRACT NOT AVAILABLE

Epidural interferon gamma-immunoreactivity: a biomarker for lumbar nerve root irritation.
Author(s): Scuderi, GJ; Cuellar, JM; Cuellar, VG; Yeomans, DC; Carragee, EJ; Angst, MS
Journal: Spine (Phila Pa 1976) 2010 Jan 6; Vol. 34, Issue 21; Page(s) 2311-7
[Medline ID - 19934811]

STUDY DESIGN: Prospective observational cohort. OBJECTIVE: Correlate epidural inflammatory cytokines with the clinical response to epidural steroid injection in patients with lumbar nerve root irritation. SUMMARY OF BACKGROUND DATA: Some back pain syndromes are thought to be associated with activation of inflammatory pathways and others may be associated with primary mechanical derangements. Human studies providing detailed evidence for the primary inflammatory causation, which may be best treated with anti-inflammatory strategies, are lacking. There are currently no accurate diagnostic tests to predict the response to epidural steroid injection or surgical intervention in back pain and sciatica syndromes. METHODS.: Forty-seven consecutive patients with lumbar degenerative changes and low back and/or leg pain were prospectively enrolled. An epidural lavage was performed, followed by injection of marcaine/depo-medrol. Subjects scored their pain before and 3 months after the procedure. The immunoreactivity of an array of cytokines was measured in lavage samples and compared with clinical response to the therapeutic injection. Ten subjects underwent repeat epidural lavage sampling 3 months after the steroid injection. RESULTS: Interferon gamma (IFNgamma) was the most consistently detected cytokine. IFNgamma-immunoreactivity also highly correlated with reported reduction of pain 3-months after the epidural steroid injection. In subjects reporting significant pain relief ( > 50%) from the injection, mean [IFNgamma] was significantly greater compared with patients experiencing no significant relief. The IFNgamma-immunoreactivity in repeat lavage samples decreased to trace residual concentrations in patients who reported pain relief from the steroid injection. CONCLUSION: The presence of epidural IFNgamma-immunoreactivity corresponding to > 10 pg/mL predicted significant pain relief after epidural steroid injection with > 95% accuracy. These results suggest that IFNgamma may be part of a biochemical cascade triggering pain in sciatica; IFNgamma-immunoreactivity may aid as a biomarker for predicting the response to steroid therapy and/or surgical intervention, and may serve as a future therapeutic target.
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