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Md Abu B Siddiq
Piriformis syndrome (PS) involves the piriformis muscle and adjacent sciatic nerve, producing features similar to true sciatica of lumbar spine origin, for example, lumbar disc prolapse, thereby confusing pain physicians about the diagnosis. Synonyms that are used frequently for PS are deep gluteal syndrome, extra-spinal sciatica, wallet neuritis, etc. Commonly presenting symptoms of PS include gluteal pain which increases with affected side sitting/per-rectal manoeuvre, and improves with ambulation/intra-lesional steroid, etc...
May 10, 2018: Curēus
Sherifa Ahmed Hamed
OBJECTIVES: Pregabalin (PGB) is a gabapentinoid (ie, GABA analog), which has been Food and Drug Administration-approved for treatment of partial epilepsy in adults and neuropathic pain. It also has off-label uses for the treatment of generalized anxiety disorders, fibromyalgia, and tension headache and prevention of migraine. Few cases were reported with sexual dysfunctions (SDs) as adverse effects of PGB and gabapentin, and the majority were dose related (≥900 mg/d for gabapentin)...
July 2018: Clinical Neuropharmacology
Yu Wang, Jin Yang, Yuqing Yan, Lifeng Zhang, Chuan Guo, Zhiyu Peng, Qingquan Kong
Recent reported results by Fang et al. published in BMC Musculoskeletal Disorders have added to the weight of evidence supporting association between gluteal pain and lumbar disc hernia. Their clinical finding shows the L4/5 level is the main level responsible for gluteal pain in lumbar disc hernia. Indeed, many possible mechanisms may explain why patients experience pain in the gluteal area. In this Correspondence, we would like to highlight several possible mechanisms of LDH-related gluteal pain based on detailed analysis of the sensory innervation of the gluteal region...
July 11, 2018: BMC Musculoskeletal Disorders
Keyvan Mostofi, Babak Gharaie Moghaddam, Reza Karimi Khouzan, Mathieu Daryabin
Although not as frequent as sciatica, cruralgia remains one of the most frequent reasons why people consult a neurosurgeon. It should be kept in mind, however, that every anterior leg pain is not cruralgia and thus several diagnoses must be discarded, such as of musculoskeletal diseases of hip, pelvis and femur. In the last years of the 19th century, André Léri, a French neurologist, described Leri's sign as it is used widely even today in everyday clinical practice. We studied retrospectively files of those patients who were seen in Neurosurgery by the authors for L3 and L4 nerve root compression to evaluate the reliability and accuracy of this sign...
April 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Ganesha K Thayaparan, Mark G Owbridge, Robert G Thompson, Paul S D'Urso
PURPOSE: Despite the variety of "off-the-shelf" implants and instrumentation, outcomes following revision lumbosacral surgery are inconstant. Revision fusion surgery presents a unique set of patient-specific challenges that may not be adequately addressed using universal kits. This study aims to describe how patient-specific factors, surgeon requirements, and healthcare efficiencies were integrated to design and manufacture anatomically matched surgical tools and implants to complement a minimally invasive posterior approach for revision lumbar fusion surgery...
July 10, 2018: European Spine Journal
Umut Orkun Çelebi, Veysel Burulday, Mehmet Faik Özveren, Adil Doğan, Mehmet Hüseyin Akgül
OBJECTIVE: The aim of this study was to compare strain elastography (SE) and shear wave elastography (SWE) findings of the sciatic nerve in patients with unilateral lumbar disc herniation (LDH) and healthy control subjects. MATERIALS AND METHODS: The study group included patients with complaints of unilateral sciatica for 3-12 months, with foraminal stenosis due to one level of LDH (L4-L5 or L5-S1). An age- and gender-matched control group was formed of healthy subjects...
July 7, 2018: Skeletal Radiology
Yi Liu, John A Carrino, Alexander S Dash, Tariq Chukir, Huong Do, Richard S Bockman, Alexander P Hughes, Joel M Press, Emily M Stein
Context: Epidural steroid injections (ESI) are a common, effective treatment for lumbar radiculopathy and sciatica. While the negative skeletal effects of oral glucocorticoids are well established, little is known about the impact of ESI on bone quality. DXA is subject to artifact in patients with spine pathology and may have limited utility in this population. Objective: To investigate the relationship between ESI exposure and volumetric bone density (vBMD) at the lumbar spine (LS) using central quantitative CT (cQCT)...
July 2, 2018: Journal of Clinical Endocrinology and Metabolism
Marissa Nichole Lassere, Kent Robert Johnson, Jeanette Thom, Grant Pickard, Peter Smerdely
INTRODUCTION: Acute sciatica (symptom duration less than 4 weeks), a major cause of pain and disability, is a common presentation to medical practices and hospital emergency departments. Selective CT fluoroscopy transforaminal epidural steroid injection is often used with the hope of reducing pain and improving function. Recently, there has been interest in using systemic corticosteroids in acute sciatica. However, there is limited evidence to inform management of selective CT fluoroscopy transforaminal epidural steroid in subacute and chronic sciatica and there is no evidence in acute sciatica, even though the practice is widespread...
July 5, 2018: BMJ Open
Péricles Maranhão-Filho, Maurice Vincent
Charles Lasègue is reputed to have described the test/sign bearing his name, but he never wrote about it and misinterpreted its mechanism. The purpose of this note is to highlight the work of the Serbian, Laza Lazarević, who was first to present the original report of this seminal sign in sciatica and provide its appropriate pathophysiological interpretation.
June 2018: Arquivos de Neuro-psiquiatria
Oliver Enke, Heather A New, Charles H New, Stephanie Mathieson, Andrew J McLachlan, Jane Latimer, Christopher G Maher, C-W Christine Lin
BACKGROUND: The use of anticonvulsants (e.g., gabapentin, pregabalin) to treat low back pain has increased substantially in recent years despite limited supporting evidence. We aimed to determine the efficacy and tolerability of anticonvulsants in the treatment of low back pain and lumbar radicular pain compared with placebo. METHODS: A search was conducted in 5 databases for studies comparing an anticonvulsant to placebo in patients with nonspecific low back pain, sciatica or neurogenic claudication of any duration...
July 3, 2018: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
M I Hasenbring, C Levenig, D Hallner, A-K Puschmann, A Weiffen, J Kleinert, J Belz, M Schiltenwolf, A-C Pfeifer, J Heidari, M Kellmann, P-M Wippert
BACKGROUND: Lumbar back pain and the high risk of chronic complaints is not only an important health concern in the general population but also in high performance athletes. In contrast to non-athletes, there is a lack of research into psychosocial risk factors in athletes. Moreover, the development of psychosocial screening questionnaires that would be qualified to detect athletes with a high risk of chronicity is in the early stages. The purpose of this review is to give an overview of research into psychosocial risk factors in both populations and to evaluate the performance of screening instruments in non-athletes...
June 26, 2018: Der Schmerz
Haomiao Jia, Erica I Lubetkin, John P Barile, Willi Horner-Johnson, Kimberly DeMichele, Debra S Stark, Matthew M Zack, William W Thompson
BACKGROUND: Although the life expectancy for the US population has increased, a high proportion of this population has lived with ≥1 chronic conditions. We have quantified the burden of disease associated with 15 chronic conditions and combinations of conditions by estimating quality-adjusted life years (QALYs) for older US adults. RESEARCH DESIGN: Data were from the Medicare Health Outcomes Survey Cohort 15 (baseline survey in 2012, follow-up survey 2014, with mortality follow-up through January 31, 2015)...
June 22, 2018: Medical Care
Mingdong Yu, Baohui Su, Xiaoxia Zhang
OBJECTIVES: Here, using rat model, we investigated the roles of gardenoside in the chronic constriction injury (CCI) of the ischiadic nerve. METHODS: Bennett and Xie's unilateral sciatic nerve CCI model was used in this study. A total of 60 rats were divided into control group (CN), sham group (Sham), CCI group, and gardenoside administrated CCI group. An aliquot of 5 mL gardenoside solution was administrated through gavage once per day for 14 d. Mechanical withdrawal threshold (MWT) and the thermal withdrawal latency (TWL) were detected...
June 22, 2018: Journal of Receptor and Signal Transduction Research
Mark A Pacult, Fraser C Henderson, Mathew D Wooster, Abhay K Varma
The authors report the case of a 76 year-old woman presenting with leg pain, numbness and weakness mimicking a lumbosacral radiculopathy. Lumbar spine magnetic resonance imaging (MRI) demonstrated mild root compression but lumbar decompression afforded only transient symptomatic relief. Post-operative MRI of the lumbosacral plexus and sciatic nerve revealed a gluteal venous varix compressing the sciatic nerve just distal to the piriformis muscle. Neurolysis and surgical resection of the offending varix resulted in resolution of her symptoms...
June 18, 2018: World Neurosurgery
M B Olsen, L M Jacobsen, E I Schistad, L M Pedersen, L J Rygh, C Røe, J Gjerstad
Background/aims The μ-opioid receptor (OPRM1) is the major target of endogenous opioid peptides and opioid analgesic agents. An important single nucleotide polymorphism (SNP) in this gene is the functional SNP, rs1799971, leading to a substitution of asparagine (Asn) to aspartic acid (Asp) at codon 40 in exon 1. Previous studies have suggested that this SNP may give different phenotypes in males and females. In the present study we therefore investigated whether the OPRM1 Asn40Asp SNP, grouped by gender, could predict clinical outcome regarding progression of pain intensity and disability in patients with discogenic low back pain and sciatica...
December 29, 2017: Scandinavian Journal of Pain
John D Markman, Ralf Baron, Jennifer S Gewandter
This review examines the stark contrast between the successes and failures of the clinical development of analgesics for different types of chronic low back pain (CLBP) syndrome over the past three decades. Multiple drugs with differing mechanisms of action have been developed for nonspecific axial-predominant low back syndromes and yet not a single therapy is indicated for any neuropathic low back pain syndrome (e.g., sciatica). Clinician findings have informed the entry criteria for neuropathic low back pain clinical trials, whereas entry criteria of axial CLBP trials have prioritized only patient reports of pain...
June 9, 2018: Drug Discovery Today
Cristina Barrena López, Beatriz De la Calle García, Rosario Sarabia Herrero
Ganglioneuroma (GN) is a slow-growing tumor originating from the neural crest-derived cells, which form the sympathetic nervous system. These tumors can affect anywhere along the peripheral autonomic ganglion sites, being most commonly found in the mediastinum and retroperitoneum. Spinal GNs are extremely rare and, so far, only 1 case arising from a lumbar nerve root has been reported in English literature. GNs are often asymptomatic, and the majority of them, are found incidentally in healthy subjects. Due to its slow growth, symptoms may result from the compressive effect of the tumor...
June 7, 2018: World Neurosurgery
Patricia Parreira, Chris G Maher, Daniel Steffens, Mark J Hancock, Manuela L Ferreira
BACKGROUND: Low back pain (LBP) is a highly prevalent condition and it is associated with significant disability and work absenteeism worldwide. A variety of environmental and individual characteristics have been reported to increase the risk of LBP. To our knowledge, there has been no previous attempt to summarize the evidence from existing systematic reviews of risk factors for LBP or sciatica. PURPOSE: To provide an overview of risk factors for LBP, we completed an umbrella review of the evidence from existing systematic reviews...
May 21, 2018: Spine Journal: Official Journal of the North American Spine Society
Mark H Ebell, Roland Grad
Based on systematic surveillance of more than 110 medical journals, 247 studies met criteria as POEMs (patient-oriented evidence that matters) in 2017. Members of the Canadian Medical Association identified 20 of these POEMs as most relevant to practice. This article reviews the clinical questions and bottom-line answers from these studies. Blood pressure should be measured after a period of rest, using a bare arm, and orthostatic blood pressure is more predictive when measured after one minute of standing rather than three minutes...
May 1, 2018: American Family Physician
C Champeaux, A Drier, B Devaux, A Tauziède-Espariat
INTRODUCTION: Malignant primary diffuse leptomeningeal gliomatosis (MPDLG) are rare central nervous system neoplasms associated with a poor outcome. CASE REPORT: We report the case of a 40-year-old woman who presented with unusual worsening of bilateral sciatica, headaches, diplopia and a left proptosis. MRI of the head and spine showed multiple leptomeningeal lesions with no intra parenchymal involvement. The search for a primary tumor was negative. An open surgical biopsy of the prominent intradural lumbar tumor was performed within a week...
May 8, 2018: Neuro-Chirurgie
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