Sciatica Differential Diagnosis Manoj Krishna, FRCS, MCh(Orth) Spine Surgeon www.spinalsurgeon.com
Chemistry of a disc prolapse • TNF Alpha • Phospholipase A2 • Interleukin 6 • Prostaglandin E2 • Matrix Metallo-proteinases • Nitric Oxide
Natural History- Disc prolapse and Sciatca. Surgery vs Conservative treatment • Weber: At 1 yr- op group better. At 4 years, slightly better. At 10 years no difference. • SPORT Trial: Both groups better at 2 years. Op group slightly better • 80% of discs show a reduction in size of 50% or more on serial MRI/CT. The largest discs resorb the most.
Different patterns of disc degeneration CENTRAL DISC HERNIATION ASSOCAITED WITH MORE CHRONICITY AND MORE BACK PAIN ON LOADING
Causes of Leg Pain • Piriformis Syndrome • Spinal Stenosis • Disc protrusion • Synovial Cyst • Tumours: Neurofibroma • Infection: Abscess • DVT • Iliotibial band syndrome • Hip Arthritis • Psoas Haematoma • Retroperitoneal tumour • Vascular ClaudicationInflammatory radiculopathy • Diabetes • Sciatic Nerve tumours • Meralgia Paraesthetica
Hip Arthritis can mimic Sciatica! The hip can give you a slip ! -Anterior thigh pain -Antalgic gait -Positive active SLR . -Hip rotations painful / restricted -Trendelenburg’s positive
65. M. 12m history of moderate back and leg pain. Present even at rest. 6.5cm diameter. No abdominal pain. MRI scan done for Low Back Pain. Needs surgical excision and reconstruction.
Neurofibroma causing Radicular Pain With Gadolinium AM.57 male. Left buttock, and leg pain for 12 months. No postural relief. Widespread Neurofibromatosis.
Piriformis syndrome Sciatic Nerve Entrapment under Piriformis Muscle Tender in buttock Cant sit on buttock Passive rotation of hip is painful EMG studies Rx- PhysioRx, Surgical release