Search

Study Design: Prospective cohort study., Objective: To identify potential prognostic factors for persistent leg-pain at 12 months among patients hospitalized with acute severe sciatica., Summary of Background Data: The long-term outcome for patients admitted to hospital with sciatica is generally unfavorable. Results concerning prognostic factors for persistent sciatica are limited and conflicting., Methods: A total of 210 patients acutely admitted to hospital for either surgical or nonsurgical treatment of sciatica were consecutively recruited and received a thorough clinical and radiographic examination in addition to responding to a comprehensive questionnaire. Follow-up assessments were done at 6 weeks, 6 months, and 12 months. Potential prognostic factors were measured at baseline and at 6 weeks. The impact of these factors on leg-pain was analyzed by multiple linear regression modeling., Results: A total of 151 patients completed the entire study, 93 receiving nonrandomized surgical treatment. The final multivariate models showed that the following factors were significantly associated with leg-pain at 12 months: high psychosocial risk according to the Örebro Musculosceletal Pain Questionnaire (unstandardized beta coefficient 1.55, 95% confidence interval [CI] 0.72-2.38, P < 0.001), not receiving surgical treatment (1.11, 95% CI 0.29-1.93, P = 0.01), not actively employed upon admission (1.47, 95% CI 0.63-2.31, P < 0.01), and self-reported leg-pain recorded 6 weeks posthospital admission (0.49, 95% CI 0.34-0.63, P < 0.001). Interaction analysis showed that the Örebro Musculosceletal Pain Questionnaire had significant prognostic value only on the nonsurgically treated patients (3.26, 95% CI 1.89-4.63, P < 0.001)., Conclusion: The results suggest that a psychosocial screening tool and the implementation of a 6-week postadmission follow-up has prognostic value in the hospital management of severe sciatica., Level of Evidence: 2.

A pseudohypertrophy of the calf can be rarely associated with neurogenic pathologies as S-1 radiculopathy, poliomyelitis, spinal muscular atrophy, traumatic lesions of peripheral nerves, intraspinal neurinoma. The causes of this particular phenomenon are unknown. The authors present the case of a 52-year-old man with an enlargement of the left calf suffering from a mild form of spinal paralytic poliomyelitis in the early childhood and episodes of severe left sciatica in the last four years. Electromyography demonstrated a pattern of denervation in both legs and an H-reflex absent when the left tibial nerve was stimulated. An open muscle biopsy of the left calf was performed. Light microscopic and ultrastructural examination of the muscle confirmed the presence of a pattern of "neurogenic type" pseudohypertrophy. Our results could be interesting for the understanding of the mechanism of neurogenic pseudohypertrophy. This case suggests that timing of stimulus or "dose" of denervation may be important factors in such a phenomenon.

Study Design: The present study attempts to document deep vascular abnormalities of the lower extremity in cases of sciatica secondary to discal herniation using Tc-99m methylene diphosphonate angiography., Objectives: Vascular abnormalities are studied compared with the contralateral extremity and normal control subjects. An attempt is made to determine the clinical usefulness of the current technique. SUMMARY OF BACKGROUND DATA. Thermography has occasionally evidenced a decreased cutaneous temperature in patients with sciatica. There have been no studies to date looking at the total vascular flow in this condition, mainly constituted by the muscular perfusion., Methods: Thirty patients with sciatica secondary to discal herniation, 16 patients with chronic low back pain referred to the thigh, and 31 control subjects were examined by isotopic angiography of the posterior aspect of the thigh after intravenous injection of Tc-99m methylene diphosphonate. The affected side was compared with the nonpainful side, and the difference was expressed as a percentage. Control subjects were used as reference values., Results: Abnormality in vascularization of the lower extremity was found in 24 (80%) of patients with sciatica and in 11 (68.7%) of the patients with low back pain. The median blood flow difference was, respectively, -12.5% and +4% in these two groups versus +2.9% in the control group. The differences between the sciatica group and the other groups were statistically significant. No correlation was found with the clinical parameters studied., Conclusion: Vascular perfusion abnormalities observed in patients with sciatica secondary to disc herniation may be more important than previously considered and possibly result from alteration in sympathetic vascular autoregulation.

Back and leg complaints were studied by using a questionnaire and medical examination in 183 male conscripts and relating the results to background variables, anthropometry, the isometric strength of large muscle groups, and endurance running. A history of sciatica was reported by 8%, lumbago by 13%, back injury by 13% and low back insufficiency by 63%. Weak trunk extensors were associated with a history of sciatica, weak trunk flexors with back injuries and with current backache at work/exercise. Weak leg extensors showed associations with a history of low back insufficiency and of sick leave due to the back and with current hip pain. Men with a history of lumbago and of hip and knee complaints performed poorly during 12 min of running. Back and leg complaints were more frequent in men with high socio-economic status, who engaged in little physical activity, or who were obese. The questionnaire and strength measurements proved suitable for studying low back syndrome in its early stages.