Sciatica Causes and 4 case presentations

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SciaticaCauses and 4 case presentations

• Manoj Krishna
• Spinal Surgeon

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Causes of Sciatica

• Lumbar Disc Prolapse
• Degenerative Disc Disease without neural
  compression
• Lateral Recess Stenosis
• Neurofibroma and other tumours
• Facet Joint Cyst

• Epidural Abscess
• Spinal Cord Tumour
• Piriformis Syndrome
• Diabetic Neuropathy
• Vascular Claudication
• Ilio-Tibial band Syndrome

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Sciatica Caused by Neural Compression by Disc
Prolapse
44 year old patient. 20 year history of
intermittent low back pain 3 month history of
severe right sided sciatica Right L5/S1 Disc
Prolapse. Disc degeneration at L45 and
L5/S1 Failed a course of physiotherapy. On
Tramadol, Diclofenac and Paracetamol.
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First line of Rx
Sacral Epidural Injection. Good pain relief for 2
weeks and then symptoms recurred. Sometimes an
epidural injection and nerve root block is all
the patients need. This patient needed
surgery I thought it was best to deal with all
his pain generators in one operation- including
the discs, the facet joints and the nerves. A
discectomy alone would have dealt with his leg
pain, but may have left him with residual back
pain.
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L4-S1 Posterior Lumbar Interbody Fusion done
Reported significant improvement in symptoms. At
6 weeks was virtually pain free. To see this
patient talking about his experience of surgery
see Video Section of website www.kspine.net,
video 31, in PLIF series.
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Sciatica caused by referred pain from a disc
without neural compression
53 year old patient. Left sided buttock pain
radiating down left leg up to knee for 2
years.Recurring flare-ups. Pain aggravated on
sitting. Not sleeping well Tried Physio for 7
months. On Gabapentin, Amitrptilline, Oxyxontin
. Left L34 Nerve Root Block- no benefit MRI-
Degenerative changes at L34. No neural
compression. ?? Cause of Pain, and what are the
treatment options
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F53
L34 Analgesic Discogram. Local Anesthetic and
Omnipaque dye injected into the disc space. All
her back and left thigh pain eased for 4 weeks .
Was able to sleep comfortably for first time in 2
years
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L34 Posterior Lumbar Interbody Fusion- complete
relief of pain
Reports complete relief of pain 4 weeks after
surgery.
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Messages

• Inflamed discs can cause referred leg pain
  without neural compression by irritating the
  sinu-vertebral nerve
• Mild disc degeneration can result in quite severe
  pain- because of inflammatory chemicals in the
  disc space- not seen on MRI scans
• Analgesic Discography- a new technique offers a
  simple way to confirm the relevant disc as the
  pain generator
• Interbody fusion can then be used to treat the
  problem definitively.

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Neurofibroma causing Radicular Pain
With Gadolinium
AM.57 male. Left buttock, and leg pain for 12
months. No postural relief. Widespread
Neurofibromatosis. MRI shows Neurofibroma at L34
on the left. Rxed by surgical excision.
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Sciatica caused by L45 Facet Joint Cyst.
Severe Right sided leg pain and Low back
pain Treated with decompression surgery Immediate
pain relief
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Sciatica Caused by Spinal Tumor and Vertebral
Fracture
Presents with h/o fall feb 06. c/o- right leg
pain- xray L3 Epidural and nerve root block in
June 06- pain goes away. Also raised ESR86.
Diagnosed with Polymyalgia Rheumatica. Given
Steroids. Serum electrophoresis ve Diagnosed
with Multiple Myeloma. On chemotherapy. Still in
Pain Vertebroplasty- relieved his pain.