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The persistent sciatic artery is an uncommon disease, considered an axial congenital vascular malformation due to the lack of involution of the sciatic artery during embryonic development. It may be associated with abnormalities in the development of the iliac, common femoral and superficial femoral arteries. Patients may be asymptomatic, or they could present chronic pain, such as sciatic neuralgia, caused by nerve damage, since it is close to the abnormal persistent vessel, or due to ischemic pain, as a result of a thrombosis or embolism of an aneurysm, which could compromise the viability of the limb.

OBJECTIVE Sciatica is the hallmark symptom of a lumbar disc herniation (LDH). Up to 90% of LDH patients recover within 12 weeks regardless of treatment. With continued deteriorating symptoms and low patient quality of life, most surgeons recommend surgical discectomy. However, there is not yet a clear consensus regarding the proper timing of surgery. The aim of this study was to evaluate how the duration of preoperative leg pain (sciatic neuralgia) is associated with patient-reported levels of postoperative leg pain reduction and other patient-reported outcome measures (PROMs) in a prospectively collected data set from a large national cohort. METHODS All patients aged 18–65 years undergoing a lumbar discectomy during 2013–2016 and registered in Swespine (the Swedish national spine registry) with 1 year of postoperative follow-up data were included in the study (n = 6216). The patients were stratified into 4 groups according to preoperative pain duration: < 3, 3–12, 12–24, or > 24 months. Patient results assessed with the numeric rating scale (NRS) for leg pain (rated from 0 to 10), global assessment of leg pain, EQ-5D, Oswestry Disability Index (ODI), and patient satisfaction with the final surgical outcome were analyzed and compared with preoperative values and between groups. RESULTS A significant improvement was seen 1 year postoperatively regardless of preoperative pain duration (change in NRS score: mean −4.83, 95% CI −4.73 to −4.93 in the entire cohort). The largest decrease in leg pain NRS score (mean −5.59, 95% CI −5.85 to −5.33) was seen in the operated group with the shortest sciatica duration (< 3 months). The patients with a leg pain duration in excess of 12 months had a significantly higher risk of having unchanged radiating leg pain 1 year postoperatively compared with those with < 12-month leg pain duration at the time of surgery (OR 2.41, 95% CI 1.81–3.21, p < 0.0001). CONCLUSIONS Patients with the shortest leg pain duration (< 3 months) reported superior outcomes in all measured parameters. More significantly, using a 12-month pain duration as a cutoff, patients who had a lumbar discectomy with a preoperative symptom duration < 12 months experienced a larger reduction in leg pain and were more satisfied with their surgical outcome and perception of postoperative leg pain than those with > 12 months of sciatic leg pain.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants are used orally or intramuscularly (IM) to treat lumbar ischialgia caused by musculoskeletal disorders or radiculopathy. A comparative study has been conducted to investigate the efficacy and safety of the NSAID meloxicam (Amelotex®) injected intramuscularly and into the trigger points in combination with tolperisone and B-group vitamins for lumbar ischialgia.Patients and methods. The investigation enrolled 62 patients aged 30–60 years with lumbar ischialgia, who were randomized into three equal groups. Group 1 patients were injected with meloxicam 1.5 ml (15 mg of its active ingredient) into the trigger points daily for 3 days, followed by one 15-mg tablet daily for 14 days; Group 2 received IM meloxicam 15 mg daily for 3 days, followed by one 15-mg tablet daily for 14 days; Group 3 had IM meloxicam 15 mg daily for 3 days, followed by one 15-mg tablet daily for 14 days in combination with tolperisone (Calmirex®) as tablets: 150 mg (Day 1 of therapy), 300 mg (Day 2), and 450 mg daily (Day 3 until the end of therapy). All the patients received IM Vitamin B complex (Compligam B®) 2 ml for 5 days. The treatment efficiency was evaluated using the pain visual analogue scale (VAS), the Oswestry disability questionnaire, and the McGill pain questionnaire, the range of motion, and the severity of neurodystrophic syndrome.Results and discussion. All the patient groups showed a rapid and substantial pain reduction on the VAS and a functional activity improvement according to the Oswestry scale, which made it possible to complete the treatment within an average of 9.6 days. Groups 3 and 1 exhibited a faster improvement and, as a result, a shorter therapy duration on 8.6±1.2 and 9.2±0.9 days than did Group 2 (8.6±1.2 days). On day 2 of treatment, there was a more considerable pain reduction on the VAS in Group 1 that received meloxicam injections into the trigger zones. The administration of meloxicam intramuscularly and into the trigger zones in combination with tolperisone and vitamin B complex was noted to be safe and well tolerated.Conclusion. The injection of Amelotex into the trigger zones is highly effective and safe in treating lumbar ischialgia. An NSAID (meloxicam) in combination with a muscle relaxant (tolperisone) speeds up recovery and shortens the duration of NSAID intake.

In order to improve oncologic outcomes in radiotherapy treatments of patients with unresectable pelvic sidewall recurrences of uterine cervical cancer, we combined high-dose-rate interstitial brachytherapy (HDR-ISBT) with newly tested hypoxic radiosensitizer Kochi oxydol-radiation therapy for unresectable carcinomas (KORTUC II), an enzyme-targeting radiosensitization treatment involving intra-tumoral injection of sodium hyaluronate mixed with hydrogen peroxide. We report on a 63-year-old patient referred to our department with an extensive pelvic sidewall recurrence of uterine cervical cancer after initial hysterectomy. The tumor size was 55 × 25 × 80 mm, with a calculated volume of 89.7 cc. Whole pelvic irradiation of 50 Gy in 25 fractions was administered, combined with weekly cisplatin injections. KORTUC II injections were given two times: at day 21 (42 Gy) and at day 24 (48 Gy). After finishing whole pelvic irradiation, HDR-ISBT of 25 Gy in 5 fractions b.i.d. over 3 days was administered. KORTUC II was also injected at the time of implantation. Dose-volume histogram (DVH) values for clinical target volume were D 90 , D 98 , and D 100 of 6.0, 5.0, and 3.5 Gy per fraction, respectively. D2cc values were 2.1, 4.1, 3.2, and 2.0 Gy per fraction for the bladder, rectum, sigmoid colon, and small bowel, respectively. No acute adverse events ≥ grade 3 were observed. Repeated grade 3 pyelonephritis occurred as a late complication at 11, 24, and 26 months after the treatment, and was successfully resolved with antibiotics. Moreover, grade 2 late toxicity was documented, including sciatic neuralgia, lower limb lymphedema, and urinary incontinence. At present, 32 months after HDR-ISBT, the patient remains free of disease, with no toxicity-related deterioration in physical condition.

Introduction: Among chronic conditions, back problems are the most frequent cause of limitations of activity in persons less than 45 years of age. Sciatic neuralgia is a nerve root oedema because of the inflammatory, immunological, and mechanical factors. The lifetime prevalence of lumbar radiculopathy has been reported to be 5.3% in men and 3.7% in women. Steroid injections play an important role in the management of sciatic radiculopathy. Steroids act by reducing the oedema around the nerve roots and decreasing pain having the advantage of reduced dosage and targeted delivery around the nerve roots forming the basis of transforaminal nerve root block injections. In this study we want to study the effectiveness of transforaminal nerve root block in 30 patients post block and 3 months later. Aims and objectives: Aims and objectives of the study are as follows: 1. To study the effectiveness in relief of symptoms in transforaminal nerve root block in lumbar disc disease. Materials and Methods: The clinical and follow-up data of 30 patients having lumbar disc disease causing sciatic neuralgia were taken from May 2019 to December 2019 in MGM medical college and hospital Kamothe Navi Mumbai were retrospectively analysed in this study. Follow-up was conducted immediately after the administration of block, as well as 3 months post the administration of the root block. Preoperative VAS scoring and was done and same were repeated post block and at 3 months to observe the functional outcome of transforaminal root block. Results: The average follow-up was 6 months. At 2 to 3 weeks’ follow-up, 28 of 30 patients reported successful pain reduction. In 25 patients, this pain reduction was obtained immediately and in a further 3 patients within 4 days. In 2 patients, the nerve root block did not show a sufficient pain reduction. In total with 6months of follow up 26 patients with pain relief after the first injection had a permanent and substantial pain reduction, 16 did not require surgery, 6 had disc herniation and the remaining 3 had foraminal stenosis for which operative procedures were planned. Conclusion: From our study we can conclude that transforaminal Root block should be the first choice in treating and diagnosing patients with disc herniation. Root block is more effective in patients with disc herniation rather than canal stenosis. We also understand from our study that transforaminal Root block is more effective in early course of disease, within 6 weeks of onset of symptoms. So we conclude that larger discs should later be planned for an open or endoscopic decompression and mild and moderate disc can also be managed conservatively after a transforaminal root block. The patient’s clinical course remains the most important determinant for treatment decision in disc herniation.

Human gait has various movements by individuals and enables normal and abnormal gaits to be recognized by their characteristics. Gait abnormalities are the most common symptoms caused by various neurological disorders such as hemiparetic, myopathic, sciatic neuralgia, and Parkinson’s disease. Abnormal gaits from functional disorders have different types of characteristics. Based on the characteristics, we propose a gait abnormality recognition method that uses integrated gait features extracted from the individual’s walking movement using the Kinect depth camera. Diagnosing a detailed pathological level of the disorders requires a high knowledge of the physiological and pathological gait characteristics. Furthermore, it commonly requires a much complex environment and wearable sensors. However, using our proposed method, the initial characteristics of the gait disorders can be detected without the requirements. Thus, we build a k-NN classifier and an SVM classifier to classify abnormal gait from a walking person. In the result of our experiment, our proposed method with the gait features shows the potentiality for classifying gait abnormalities.

The patient was a 72-year-old woman who had started to feel left buttock pain 10 days prior to admission to our hospital. She visited a local clinic, where a pain killer was prescribed. However, her pain deteriorated, expanding to her back and left leg, and she became unable to walk. Thus, she was transported to our hospital. She had diabetes mellitus, dyslipidemia, chronic heart failure, and lumbar spinal canal stenosis. She was initially diagnosed with sciatic neuralgia due to lumbar spondylosis and treated with acetaminophen and returned home. The next day, however, she developed bilateral leg paralysis and difficulty speaking. When the emergency medical technicians checked her, she was in cardiac arrest. On arrival at our hospital, she obtained spontaneous circulation but ultimately died. Whole-body computed tomography revealed gas deep in the left buttock, the bilateral psoas muscles and spinal canal. A blood culture later revealed Escherichia coli infection. Physicians should pay attention when patients with a high pain threshold, including those who are elderly, female or who have diabetes mellitus, complain of refractory buttock pain.

No effect of outpatient treatment is observed in some patients with acute nonspecific lumbodynia and lumbar ischialgia; therefore they are referred to pain management departments or centers for specialized examination and treatment.Objective: to study of the anatomical causes of pain and the efficiency of celecoxib (Dilaxa) treatment in patients with acute and subacute lumbodynia and lumbar ischialgia in the inpatient setting.Patients and methods. Eighty patients (47 women and 33 men; mean age, 51.0±15.3 years) with acute and subacute lumbodynia (n=11) or lumbar ischialgia (n=69) were followed up. Pain intensity was assessed using a visual analogue scale (VAS); functional limitation was rated according to the Roland–Morris scale (RMS). To reduce the intensity of pain syndrome, patients took oral celecoxib (Dilaxa) 200 mg twice daily. Therapeutic blockades with anesthetics and glucocorticoids were used in some cases of damage to the sacroiliac joint (SIJ) or facet joints (FJ). Patients were informed of the benign nature of the disease; they did therapeutic exercises.Results and discussion. The causes of pain were ascertained to be injuries of SIJ (48,8%), FJ and SIJ (18,8%), FJ (17,5%), herniated disc (10%), piriformis syndrome (2.5%), and piriformis syndrome and SIJ injury (2.5%). The duration of treatment averaged 11.0±2.4 days. By the end of the study, there was a clinically significant reduction in pain in 86% of patients. The treatment resulted in a 2.4-fold average reduction in pain intensity (from 7.0 to 2.9 VAS scores): a 4-fold reduction in patients with lumbodynia (from 6.4 to 1.6 scores) and a 2.3-fold one in those with lumbar ischialgia (from 7.1 to 3.1. scores); the degree of disability reduced by an average of 1.9 times (from 8.1 to 4.3 RMS scores): by 3.6 times (from 6.8 to 1.9 scores) and 1.9 (from 8,3 to 4,7 scores) times in patients with lumbodynia and in those with lumbar ischialgia, respectively. No adverse events were observed during the treatment period.Conclusion. There were high SIJ and FJ injury rates in subacute lumbar ischialgia. Celecoxib was noted to be highly effective and safe in treating acute and subacute lumbar ischialgia and lumbodynia.

The aging process is accompanied by a structural change and a decrease in the functional activity of organs and tissues, including the bone, with the development of osteoporosis (OP).Objective: to assess the characteristics of pain syndrome in OP patients with nonspecific chronic vertebrogenic lumbar ischialgia (CLI).Patients and methods. Sixty elderly patients with CLI in the presence and absence of OP were examined. All the patients underwent dual-energy X-ray absorptiometry and ultrasound to diagnose the degree of OP and spinal deformity; a flexible rod was used according to the method described by M.A. Kathleen to estimate the angle of kyphosis, lordosis, and scoliosis. The investigators determined pain intensity by a numerical rating scale, the presence of a neuropathic pain component by the DN4 pain scale, the level of anxiety and depression by the Hospital Anxiety and Depression Scale, cognitive status by the Montreal Cognitive Function Rating Scale, the degree of disability by the Oswestry questionnaire, and quality of life by the SF-12 Health Survey.Results and discussion. Our study showed that OP alone is not a cause of CLI in elderly patients. There were no statistically significant differences in the sources and intensity of pain, the degree of anxiety and depressive disorders, impaired quality of life, cognitive status, and degree of disability in patients with chronic lumbar pain syndrome in the presence and absence of OP. Vertebral deformity resulting from OP leads mainly to an obvious poor posture with an increase in thoracic kyphosis, straightening of lumbar lordosis, and S-curve lumbar and thoracic scoliosis, which can also cause secondary muscle spasm.Patients with back pain in the presence of OP are treated in accordance with the general principles of management of patients with non-specific back pain, but taking into account the underlying disease. The paper presents current recommendations for the treatment of nonspecific back pain, for the management of patients with OP, as well as the updated clinical recommendations for the prevention of fractures in OP and osteopenia.Conclusion. Patients with OP are noted to have predominantly chronic musculoskeletal pain in the presence of severe spinal deformity, but the level of this evidence is very low. The features of pain syndrome in patients with nonspecific vertebrogenic chronic lumbar ischialgia in the presence of OP call for further investigations.

The purpose of this study was to confirm the effect of core stability exercise, dong-bang therapy, and combined treatment on reducing pain, pelvic correction and stress hormone concentration in patients suffering from sciatic neuralgia due to pelvic displacement. Middle aged(40~50age) suffering from sciatic neuralgia over 6 months were operated with core stability exercise, dong-bang therapy, and combined treatment 3 times a week for 12 weeks. VAS and X-ray was performed to collect pain scales and pelvic displacement data and cortisol and epinephrine concentration in blood were tested. 1. pain scale rate was reduced in all groups. especially, dong-bang therapy group and combined treatment group showed more directive pain reduce. 2. pelvic displacement improvement was not significant in core stability exercise group, and it was significant in dong-bang therapy group and combined treatment group. no significant difference was shown between dong-bang therapy group and combined treatment group. however, combined treatment group showed higher correction effect. 3. concentration of stress hormone was significantly increased in all groups after the first operation. after 12 weeks concentration level was reduced to same level before treatment. Dong-bang therapy and combined treatment improve pelvic displacement, and are effective treatments on reducing sciatic neuralgia due to pelvic displacement. combined treatment of dong-bang treatment and core stability exercise is considered an effective program of correction for pelvic displacement and maintenance.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a main tool to treat acute nonspecific low back pain (NLBP). However, no factors that influence the efficacy of these drugs have been identified to the present day.Objective: to evaluate the therapeutic effect of and tolerance to NSAIDs (meloxicam) in treating acute NLBS and to identify the factors influencing the efficacy of this drug.Patients and methods. A study group consisted of 2078 patients (mean age 46.3±13.4 years; women 56.6%) with acute NLBS who had been treated in real clinical practice. The level of pain was estimated using a 0–10 point numerical rating scale (NRS). Initially, the pain level averaged 6.69±1.65 scores; 57.0% of patients were noted to have severe pain (≥7 NRS scores). Pain at rest persisted in 32.0% of patients; that at night was in 19.0%; sensation of stiffness in 60.7%, irradiation to the leg in 28.2%, and lumbar ischialgia in 9.6%. 70.2% of patients had been previously treated with NSAIDs for NLBS, while only 28.0% rated their efficacy as good. All the patients were prescribed meloxicam at a dose of 15 mg/day for a period of up to 2 weeks. 86.1% of the patients received meloxicam intramuscular for 2 days, then orally; 13.9% took the drug only orally. 52.3% of the patients also used muscle relaxants; 17.4% received oral or intramuscular B vitamins. The study estimated the rate of complete pain relief when NSAIDs were used for up to 2 weeks.Results and discussion. Complete pain relief was achieved in 75.2% of patients. 83.7% of patients rated the effect of treatment as good or excellent. Undesired drug reactions were recorded in 4.6% of patients. Female gender had no effect on treatment outcome (odds ratio (OR)=0.967; 95% confidence interval (CI), 0.795–1.177; p=0.763). Age over 65 years, the first NLBS episode, and a good NSAID effect in a history were associated with the best treatment result: OR=2.053 (95% CI, 1.5920–2.642), pConclusion. Meloxicam at a dose of 15 mg/day is an effective and safe drug to treat acute NLBS. Patient gender has no effect on treatment outcome. Age over 65 years, the first NLBS episode, and a good response to NSAIDs in a history are associated with the best treatment results; and severe pain, persistent pain at rest and at night, irradiation to the leg, and lumbar ischialgia are related to the worst result. NSAIDs in combination with muscle relaxants and B vitamins did not improve treatment outcomes.

Les schwannomes du nerf sciatique sont des tumeurs rares. Elles se manifestent essentiellement par des névralgies sciatiques plutôt que par des déficits sensitivo-moteurs. Nous rapportons le cas d´une patiente de 30 ans présentant une douleur de la fesse droite depuis 1 an. La palpation a révélé un signe de Tinel positif. Une imagerie par résonnance magnétique (IRM) a été réalisée qui a objectivé une masse grossièrement arrondie, régulière de 2 cm de diamètre en contact intime avec le nerf grand sciatique. Une exérèse complète de la tumeur a été réalisée. Cette exérèse a permis la disparition de la douleur et l´examen anatomopathologique a conclu à un schwannome plexiforme.

INTRODUCTION Opioids remain a mainstay in the treatment of acute and chronic pain, despite numerous and potentially dangerous side effects. There is a great unmet medical need for alternative treatments for patients suffering from pain that do not result in addiction or adverse side effects. Anticonvulsants have been shown to be effective in managing pain, though high systemic levels and subsequent side effects limit their widespread usage. Our goal was to determine if the incorporation of an anticonvulsant, carbamazepine, into a biodegradable microparticle for local sustained perineural release would be an efficacious analgesic following a peripheral injury. METHODS Following induction of the chronic constriction injury model in Sprague-Dawley rats, mechanical allodynia testing was performed using von Frey filaments and thermal allodynia was evaluated using the Hargreaves method. Histology and blood work were performed to evaluate toxicity as well as to monitor drug and metabolite presence over time. RESULTS A 2-fold increase in hindpaw withdrawal thresholds in animals receiving carbamazepine-loaded microparticles relative to controls was observed for up to 14 days after treatment. Drug and metabolite had a peak blood concentration of 54.7 ng/mL and dropped off exponentially to

Background Tarlov cysts (TCs) are expanded nerve root sheaths that occur near the dorsal root ganglion and result from increased intraspinal hydrostatic pressure. TCs most frequently affect the lumbosacral plexus and therefore may cause specific symptoms such as perineal pain and neurogenic bladder, bowel, and sphincter problems. It has been estimated that 1% of the population has symptomatic Tarlov cysts (STCs). However, STCs appear to be underdiagnosed, with the pain reported by patients commonly attributed to degenerative alterations seen on MRI. The aim of the present study is to investigate the utility of a comprehensive questionnaire for use by physicians in establishing the diagnosis of STCs. Methods We compared questionnaire responses regarding patient history between 33 patients diagnosed with symptomatic TCs and 42 patients with chronic low back pain and sciatica due to disc problems or degenerative or inflammatory disorders. The diagnosis of STCs was confirmed using nerve conduction studies (NCS) and electromyography (EMG) of the sacral myotomes by an expert neurophysiologist. Results The questionnaire responses revealed specific differences in perineal symptoms (perineal pain, dyspareunia,coccygodynia), bowel symptoms (constipation, diarrhea), bladder symptoms (hesitation, retention, frequency), and anal sphincter problems (anal pain, mild fecal incontinence). Additionally, sitting, walking, and straining aggravated pain more frequently inSTC patients, and STC patients were more often forced to stop working and/or reduce their social activities. Conclusions Including the above-listed items in the patient history might facilitate differentiation of low back pain and sciatica due to STCs from that due to disc problems or degenerative or inflammatory disorders. ispartof: Acta Neurochirurgica vol:160 issue:4 pages:839-844 ispartof: location:Austria status: published

Spa bathing is known as a medical treatment for certain diseases causing chronic pains. Spa water contains mineral components which lower the specific heat of the water, resulting in a higher efficiency to warm body-core temperature. This phenomenon yields pain-relieving effect for rheumatoid arthritis, low back pain, sciatic neuralgia, fibromyalgia, etc. Here we introduce medical and biological effects of mud-spa-bathing therapy for fibromyalgia other than pain relief, the changes of blood examination data, and the telomere length of circulating leukocytes. The enrolled 7 patients with fibromyalgia syndrome were hospitalized and were subject to daily mud bathing at 40 °C for 10 min for about a month. Then, their subjective pain was reduced to about a quarter in average. They also showed lowered serum triglyceride and C-reactive protein level, maintaining the levels of aspartate transaminase and creatine phosphokinase, and increases of the red blood cell count, the serum albumin level, and the serum LDL-cholesterol level in comparison with cases without mud-bathing therapy, suggesting that mud bathing prevents inflammation and muscle atrophy and improves nutritional condition in fibromyalgia. In addition, the analysis of telomere length of peripheral leukocytes revealed a trend of negative correlation between telomere shortening and laboratory data change of hemoglobin and serum albumin. These telomeric changes can be explained hypothetically by an effect of mud bathing extending life-span of circulating leukocytes.

Ruckenschmerzen konnen manchmal hartnackig sein und die Betroffenen lange Zeit qualen. Wenn die ublichen konservativen Masnahmen erfolglos waren, fragen einige Patienten nach einer Injektionstherapie. Nachfolgend ein Uberblick uber die gangigen Methoden.

Sciatica may result from pathologies affecting the nerve both in its intraspinal and extraspinal course. In daily routine, the vast majority of cases are caused by herniation of the lumbar discs compressing the neural roots. Extraspinal causes of sciatic pain are usually underestimated and the imaging study may be completed after reporting the lumbar MRIs. However, early diagnosis of the exact etiology of sciatica is paramount for both relieving the symptoms and preventing any additional neurologic injury. In this pictorial assay, some relatively rare causes of sciatic neuralgia along the route of the sciatic nerve after leaving the sacral foramen will be displayed.

Own experience of managing 50 patients (22 men and 28 women) aged 19 to 76 years with acute nonspecific lumbodynia or lumbar ischialgia is described. As anesthesia, patients received etoricoxib (Arcoxia) 60 mg daily and muscle relaxants (Mydocalmum 150--300 mg daily or sirdalud 2--6 mg daily). Patients were informed of the favorable prognosis of the disease and received advice regarding physical activity. The duration of treatment ranged from 14 to 28 days and averaged 20,0 ± 7,9 days. Against the background of treatment, the intensity of pain based on visual analog scale decreased from 6,68 ± 5,23 to 1,10 ± 1,24 points, and disability based on the Roland Morris Disability Questionnaire - from 8,70 ± 6,21 to 1,44 ± 1.98 points; adverse events were not observed. A patient case is described in which positive effect was achieved more quickly than in the previous period of exacerbation after surgical treatment (discectomy). The results demonstrate Arcoxia efficacy and safety in the treatment of acute lumbodynia and lumbar ischialgia.

Background Sciatic neuralgia (SN) is a type of pain commonly associated with lumbosacral radiculopathy. May-Thurner syndrome (MTS) is a disease characterized by venous congestion in the left common iliac vein (LCIV) due to right common iliac artery compression. A case of MTS with SN as the first presenting symptom is described. Case Description A 53-year-old man gradually developed left SN; however, radiologic examination showed no causal findings. Conservative medical treatment did not result in satisfactory pain relief. During the follow-up period, edema and brownish skin pigmentation were noted on the left crural region. Follow-up magnetic resonance imaging of lumbar spine revealed vascular enlargement around the spine and compression of the LCIV by the right common iliac artery. Furthermore, the left S1 nerve root was compressed by enlarged veins, which was thought to be the cause of the left S1 radiculopathy and SN. After the stenosed part of the LCIV was expanded, the pain and edema in the left leg disappeared. Conclusions This is the first report of SN associated with MTS. MTS should be considered as one of the differential diagnoses of SN. Thus, symptoms such as pain, edema, and skin hyperpigmentation on the left leg should be closely noted.

Introduction: Degenerative or traumatic causes are most common in generating sciatica syndrome, which is normally treated with well-known physical therapy methods. A relatively new way of treating sciatica problems is so-called functional magnetic stimulation (FMS), whose principle is based on electromagnetic field inducing electrical field inside the body. Electrical field triggers action potential of nerve cells and that way stimulates peripheral motor nerve system. Aim: Aim of this study is to measure and estimate the effectiveness of implementing therapy with functional magnetic stimulation in regular physical treatment of sciatica syndrome. Materials and Methods: 28 male patients aged between 30 and 55 with back problem were recruited on an outpatient basis. FMS therapy was performed with TESLA Stym? device (Iskra Medical d.o.o., Slovenia) treating lumbosacral region equally on both sides of the spine. Physical examination was performed to evaluate tree parameters: the mobility of the lumbar spine in flexion and extension, together with the straight leg raise test (Lasegue sign). We estimated patients’ progress, comparing angle values of mobility from the first examination day with other examination days. Results: In FMS treated group of patients, lumbosacral flexion, extension and Lasegue test angle were significantly higher compared to day 0 on the first physical examination day (day 3) (p < 0.05). In control group such increase of a measured angle was not noticed until a second physical examination day (day 5) or a third physical examination day (day 8) (p < 0.05). Discussion: Results in this study showed that applying FMS therapy along with other standard physical therapy methods rapidly increased effectiveness of the treatment of sciatica syndrome (lat. ischialgia). It suggests that functional magnetic therapy could be suggested as a regular physical therapy method in treating this kind of pain syndromes.

Spinal Dorsal Ramus Mediated Back Pain is the second most frequently described condition (the first one being Lumbar Facet Syndrome) originating from pathology involving posterior branches of lumbar spinal nerves. Spinal Dorsal Ramus Mediated Back Pain was described as “thoracolumbar junction syndrome” by Maigne in 1989. As a rule, Spinal Dorsal Ramus Mediated Back Pain presents unilaterally within posterior branches at the levels Th11-12 and L1-2. The pain is triggered by extension and/or rotation. Typical symptoms include pain that may radiate towards the gluteal area and posterior iliac crest and does not cross the body midline. Clinical symptoms may correlate with the area supplied by the whole spinal nerve of the given segment, including both the posterior and anterior branch. For this reason, patients may report not only low back pain, but also pseudovisceral pain in the hypogastric area, false sciatic neuralgia, tenderness of the pubic symphysis and hypersensitivity of the intestines. The above symptoms may lead to diagnostic difficulties. Diagnostic work-up may benefit from performance of the Kibler Fold Test to determine sensitivity of the tissues surrounding the iliac crest. Patients with Spinal Dorsal Ramus Mediated Back Pain respond well to manual manipulative techniques if these are delivered in a technically correct manner and address the appropriate segment. A recommended approach for patients with absolute contraindications to manipulation, i.e. advanced osteoporosis or osteogenesis imperfecta, is a block of the po­sterior branch of the spinal nerve involved.

Background: Sciatic neuralgia is a result of nerve root oedema because of the inflammatory, immunological and mechanical factors. Steroid injections play an important role in the management of sciatic radiculopathy. Steroids act by reducing the oedema around the nerve roots and decreasing pain. Locally administered steroids have the advantage of reduced dosage and targeted delivery around the nerve roots. This forms the basis of epidural steroid injections. This can be given around the nerve root in the transforaminal space or in the interlaminar space. There is a paucity of literature comparing the two techniques of epidural steroid injections. We have done a randomized comparative trial, to compare the effectiveness of the two modalities of injection in the management of a single level unilateral foraminal disc herniation.Methods: Patients were randomized in two groups Group A: Transforaminal epidural (SNRB) and Group B: interlaminar epidural. Same dose of steroid was used in each group.Results: Immediate post injection, 2 week and 1 month transforaminal epidural (SNRB) was better compare to interlaminar epidural however at the end of 3 months the difference was not significant (p=0.08).Conclusions: Both transforaminal and interlaminar epidural injection are effective form of treatment in mild to moderate grade of disc disease. Both the technique provide short lasting relief in the symptoms associated with disc pathology, however pain management is better in transforaminal group compared to interlaminar group. Thus these techniques can be considered for delaying surgery and providing intermitant relief.

Eucommia ulmoides Oliv. Bark (EUE) is commonly used for the treatment of hypertension, rheumatoid arthritis, lumbago, and ischialgia as well as to promote longevity. In this study, we tested the effects of EUE aqueous extract in graded doses to protect and enhance cognition in scopolamine-induced learning and memory impairments in mice. EUE significantly improved the impairment of short-term or working memory induced by scopolamine in the Y-maze and significantly reversed learning and memory deficits in mice as measured by the passive avoidance and Morris water maze tests. One day after the last trial session of the Morris water maze test (probe trial session), EUE dramatically increased the latency time in the target quadrant in a dose-dependent manner. Furthermore, EUE significantly inhibited acetylcholinesterase (AChE) and thiobarbituric acid reactive substance (TBARS) activities in the hippocampus and frontal cortex in a dose-dependent manner. EUE also markedly increased brain-derived neurotrophic factor (BDNF) and phosphorylation of cAMP element binding protein (CREB) in the hippocampus of scopolamine-induced mice. Based on these findings, we suggest that EUE may be useful for the treatment of cognitive deficits, and that the beneficial effects of EUE are mediated, in part, by cholinergic signaling enhancement and/or protection.

Inferior cluneal nerve entrapment syndrome is frequently a missed diagnosis, confused with sciatic neuralgia or ischial bursitis. A positive diagnostic block at the lateral and inferior edges of the ischium without radicular hypoesthesia or weakness may suggest inferior cluneal nerve pathology.

The management of an advanced multi-compartment prolapse requires a combination of techniques. The objective of this study was to report the anatomical outcomes of a prospective randomised trial comparing tension-free polypropylene mesh-reinforced anterior vaginal prolapse with anterior colporrhaphy at the time sacrospinous colpopexy and posterior fascial plication for the management of massive uterovaginal prolapse. A total of 116 patients with a stage III or IV (Pelvic Organ Prolapse Quantification System/International Continence Society) uterovaginal prolapse were randomised into two groups. The mesh group includes transvaginal cystocele repair using a tension-free polypropylene mesh, while the non-mesh group includes anterior colporrhaphy. All patients in the two groups underwent a sacrospinous colpopexy and posterior fascial plication. The primary outcome was objective success < stage 2 prolapse. The secondary outcomes were reoperation for recurrent prolapse, subjective success rates, patient satisfaction with the surgery and complications. The overall objective success rates (in all compartments) were 79 % (42/53) in the mesh group and 62 % (39/63) in the non-mesh group (p = 0.043). The objective success rates in the anterior compartment were 85 % (45/53) in the mesh group and 62 % (39/63) in the non-mesh group (p = 0.006). Three (6 %) patients in the mesh group and 12 (19 %) in the non-mesh group underwent repeat surgery for recurrent pelvic organ prolapse (p = 0.03). The subjective success rates were 89 % (47/53) in the mesh group and 76 % (48/63) in the non-mesh group (p value = 0.08). The mean patient satisfaction rates with the surgery were 84 % in the mesh group and 76 % in the non-mesh group (p = 0.08). The development of a urinary tract infection, right-sided buttock pain (temporary sciatic neuralgia) and new-onset stress urinary incontinence were not significantly different between the two groups. The mesh exposure rate was 8 %. Transvaginal cystocele repair using tension-free polypropylene mesh at the time of sacrospinous colpopexy and posterior fascial plication offers lower anatomic recurrence and less need for further prolapse surgery to correct recurrent pelvic floor defects than anterior colporrhaphy, sacrospinous colpopexy and posterior fascial plication.

BackgroundSciatica, better defined as sciatic neuralgia or lumbosa-cral radicular syndrome (LSRS), is a frequently diag-nosed debilitating spine disorder with an estimated yearlyincidence of 5–10 per 1,000 persons [22]. The societalimpact of low back-related disorders is quite high, as theyremain the number one cause of work disability in mostWestern countries. Sciatica manifests itself as radiatingdermatome pain regularly accompanied by diminished jerkreflexes, sensory and motor deficits. The most commoncause is a herniated lumbar disc, sometimes combinedwith bony involvement, compressing an exiting nerveroot. Less often the radicular pain is caused by a diabeticneuritis, poly-radiculoneuropathy, or tumor. Althoughlumbar disc surgery is frequently performed, the timingof this intervention and the preferred technique were untilrecently important points for debate. The performednumbers of low-back surgeries vary widely between andeven within countries and the used intervention techniquesdo seem to be based on personal or societal preferencesinstead of evidence-based medicine [10]. Currently,scientific study results have been added to medicalknowledge making rational approaches for optimal spinecare possible.DiagnosisUntil recently, classical neurological signs of LSRS wereused as a so-called accurate diagnostic tool and decision aidto refer patients for radiological confirmation of a pre-testhigh probability of nerve root compression by a herniateddisc fragment. Subsequently, a surgical indication wasroutinely made by using the same neurological signs andsymptoms as well as the correlating radiological morphol-ogy as used for diagnosis. Although it is very plausible toexpect that a good fitting history of dermatomal radiatingleg pain with provocation by the straight leg raising test andconcomitant neurological signs will result in excellentresults by surgery, scientific data are still lacking. Patientswith absent provocation by the straight leg raising testmight risk negative advice for subsequent neurosurgicalcounseling, while, vice versa, positive provocation testssometimes lead to unrealistically high expectations ofsurgical outcome. Late in the 20th century, the bed resttrial showed evidence that the diagnostic value of classicalneurological signs is not as accurate as was assumedbeforehand [18]. The most important diagnostic variablewas the dermatomal area of radiating pain. Moreover, inthis landmark study, even in patients with a clear-cutradicular syndrome confirmed by a neurologist, a herniateddisc could not be confirmed by experienced neuroradiolo-gists in one-third of the cases. This well-performed studyraised serious doubts with regard to the diagnostic value ofour neurologically trained methods of examination andclinical textbooks. Surgical studies confirmed the lack ofconsensus with regard to the exact description anddiagnosis of the LSRS caused by a herniated disc. Besidesthe diagnostic inaccuracy, classical signs fail to discriminatebetween patients that will be cured by nature compared tothose that might benefit by surgery. The presumed

Summary Introduction The main tumor of cerebellopontine angle are vestibular schwannoma (80–90%). According to National Institute of Health Consensus Development Conference the best treatment method is microsurgery. There are three principal surgical approaches: translabyrinthin, retrosigmoid and middle fossa. Only the latter two approaches provide the possibility of hearing preservation. Aim Technique of surgery and postoperative morbidity after MFA. Material and methods 39 patients (40 tumor) suffered from tumor of cerebellopontine angle, operated by using middle fossa approach in years 1998–2007. We evaluate hearing preservation and function of facial nerve and others postoperative morbidity. Results 22.5% of patients has hearing impairment and 32.5% has facial weakness. By individual cases we observed: CSF leak, meningitis, corneal ulceration, ischialgia, wound bleeding and venue thrombosis. 1/3 of patients suffered from headache and disequilibrium and 1/6 suffered from tinnitus. Conclusion According to NIH middle fossa approach is one of three possible approaches in microsurgery of cerebellopontine angle tumors. There is possible total tumor removal with hearing preservation. Monitoring of facial and cochlear nerve during operation is recommended.

Objective: To evaluate the feasibility and clinical efficacy of bilateral decompression via unilateral fenestration (BDUF) with mobile microendoscopic discectomy (MMED) for lumbar spinal stenosis. Methods: From June 2007 to June 2009, 32 patients were treated by the technique of BDUF with MMED for lumbar spinal stenosis in our hospital. All patients complained of bilateral sciatic neuralgia and intermittent claudication that was dominant in one limb. CT scan and MRI revealed disc herniation and bilateral stenosis of the spinal canal. Patients with bilateral severe osseous stenosis and multilevel stenosis were excluded. Results: The procedure was technically successful in all patients, bilateral decompression and spinal canal enlargement being achieved by unilateral fenestration. The mean operative time was 70 min (range, 50–100 min), with a mean blood loss of 150 ml (range, 50–350 ml). No significant complication was noted; dural tears were encountered in only two patients without obvious side effects. The patients were followed up for 3 to 24 months (mean, 12 months) and the clinical results were excellent in 21 cases and good in 11 cases according to the MacNab scale. Conclusion: The procedure of BDUF can be performed in conjunction with the MMED technique for lumbar spinal stenosis with good clinical results; however, severe bilateral osseous stenosis may be not suitable for this technique.

Confusion between radicular and nerve trunk syndrome is not rare. With sciatic pain, any nerve trunk pain or an atypical nerve course should suggest nerve trunk pain of the sciatic nerve in the buttocks. The usual reflex with sciatic pain is vertebral-radicular conflict. The absence of spinal symptoms and the beginning of pain in the buttocks and not in the lumbar region should reorient the etiologic search. Once a tumor of the nerve trunk has been ruled out (rarely responsible for pain other than that caused by tumor pressure), a myofascial syndrome should be explored searching for clinical, electrophysiological, and radiological evidence of compression of the sciatic trunk by the piriform muscle but also the obturator internus muscle. Hamstring syndrome may be confused with this syndrome. Treatment is first and foremost physical therapy. Failures can be treated with classical CT-guided infiltrations with botulinum toxin. Surgery should only be entertained when all these solutions have failed.

Hamstring rupture usually occurs in professional athletes, but is rarely associated with sciatic neuropathy. Proximal hamstring rupture is much more often reported than distal rupture. Entrapment of the sciatic nerve from perineural scarring and muscle fibrosis is responsible for late neurologic sequelae of injury to the hamstring muscles. There is currently no literature reporting the incidence of acute or delayed sciatic neuralgia after proximal hamstring muscle rupture. The association between distal hamstring rupture and sciatic nerve injury is extremely rare. A few cases of isolated rupture of the distal semimembranosus tendon complex have been reported recently, but without neurological sequelae. We present the first case of distal semimembranosus muscle rupture with delayed sciatic neuropathy and explain its unusual cause other than perineural scarring.

Objective. To study the influence of complex conservative teratment on severity of pain at rest, on movement, and at night in patients with hip-spine syndrome. Material and Methods. Severity of pain was assessed in 18 patients with hip-spine syndrome. Examination was conducted before and at different terms after the complex conservative treatment. Severity of pain syndrome was assessed using digital rating and visual analogous scales. Results. Complex conservative therapy was found to considerably reduce pain at rest, on movement, and at night in the first group of patients with hip-spine syndrome, and this effect remained unchanged at long-term follow-up. In the second group the reduction of pain on movement was rather limited, and pain severity returned to the initial level in a year and a half after the treatment. Conclusion. Complex conservative treatment significantly influences the severity of pain in patients with hip-spine syndrome suffering from coxarthrosis grade 1 and 2 and lumbar osteochondrosis without severe neurological symptoms. The group of patients with coxarthrosis grade 3 and lumbar osteochondrosis with chronic lumbar ischialgia showed lesser reduction in pain scores after the treatment, especially for pain on movement, therefore this group of patients requires more radical treatment.

Background Gelsolin is a highly conserved intracellular actin-binding protein with an extracellular isoform, plasma gelsolin, for which there is not yet a clearly defined function. Materials and methods In this study, we determined gelsolin concentrations in blood and cerebrospinal fluid (CSF) obtained from 25 subjects using immunoblotting and a functional assay that quantifies gelsolin's ability to accelerate actin polymerization. Results The gelsolin concentration in CSF, determined by quantitative immunoblotting was 1.2-15.9 microg/ml (average 5.9 +/- 3.8 mug/ml). In samples obtained from patients diagnosed with conditions that do not alter standard CSF clinical tests [(idiopathic cephalgia, ischialgia due to discopathy, and idiopathic (Bell's) facial nerve palsy or entrapment radial neuropathy)], the average gelsolin concentration was 7.2 +/- 4.3 microg/ml. In contrast, the gelsolin concentration in samples obtained from patients diagnosed with multiple sclerosis was 2.1 +/- 0.7 microg/ml, and a similar low concentration was found in a patient recovering from a subarachnoid hemorrhage. The range of CSF gelsolin concentrations determined by the actin polymerization assay was 0.61-9.97 microg/ml (average 3.6 +/- 2.2 microg/ml). These lower values compared with those obtained from immunoblotting analysis suggest that CSF gelsolin may bind other CSF molecules leading to a reduction of its actin-binding activity. Conclusions The results presented here show that CSF gelsolin concentration is significantly altered in certain neurological conditions, including multiple sclerosis, indicating the possible utility of CSF gelsolin levels for diagnostic purposes.

As a minimal invasive alternative to open disc surgery percutaneous nucleotomy has remarkably development for the treatment of contained lumbar herniation. In our experience since 1979, today available percutaneous concepts have to be clearly individualized in their range of indication following their specific technical limits. So a direct correlation of operative results remain restricted on overlapping ranges of indications. Progress in the technical field, in correlation with discoscopy, introduced since 1982, brought percutaneous interbody fusion in 1988, alloplastic percutaneous implants are in development. This facts let us foresee a remarkable evolution of percutaneous spine surgery comparable to arthroscopic knee surgery in the near future.

The case we present here is that of a fifty-year-old male patient who first came to the Orthopedic Hospital for out-patient treatment suffering from symptoms of lumboischialgia. Shortly afterwards, he developed symptoms characteristic of paraplegia. It was only 21 days after the initial symptoms had manifest themselves that the tentative previous diagnosis, suspected "spinal infarct", could be confirmed by magnetic resonance tomography (MRT). Possibilities offered by differential diagnosis are discussed; the discussion is followed by an enumeration of this highly heterogeneous group of illnesses.

Die vorliegende Arbeit liefert einen Uberblick und eine kritische Analyse der Literatur zum Piriformissyndrom (PS). Das PS gilt mehrheitlich als Engpasssyndrom des N. ischiadicus im Foramen infrapiriforme, verursacht durch pathologische Veranderungen des M. piriformis. Die Diagnosenstellung erfolgt primar klinisch. Das am haufigsten beschriebene Symptom ist Gesasschmerz, gefolgt von Schmerzen in der Oberschenkelruckseite und bei Palpation der tiefen Gesasmuskeln. Fur die eigens zur Diagnostik des PS entwickelten Tests gibt es keine kritische Evaluation. An der Schmerzentstehung konnten weitere Muskeln im dorsalen Becken wie der M. obturatorius internus beteiligt sein. Die nach Sacketts 52 Evidenzpyramide bewertete Qualitat der Studien ist grostenteils gering. This article presents an overview and a critical analysis of the literature concerning the piriformis syndrome (PS). PS is generally considered as an entrapment syndrome of the sciatic nerve in the infrapiriform foramen caused by pathologic alterations of the piriform muscle. Diagnosis is mainly carried out clinically. The most frequently described symptom is buttock pain followed by pain in the posterior thigh and on palpation of the deep gluteal muscles. There exists no critical evaluation of the tests specifically developed for the diagnosis of PS. Other muscles such as the obturatorius internus muscle could possibly also be involved in the development of pain. The studies were assessed by Sackett’s 52 evidence pyramid and were mostly found to be of low quality.

Objective Adam Politzer was one of the most well-known otologists of the 19th century. Unfortunately, very little is known about his life during his years as a medical student and about his publications in Hungarian. The aim of this study is to summarize Politzer's student years between 1854 and 1859 and his 13 publications in Hungarian. Data sources Eleven of Politzer's 13 Hungarian publications were published while he was a student, and the remaining two were published in 1862 and 1908. These are rarely mentioned in Politzer's curriculum vitae. Conclusion The student publications concern only general medicine and deal with pleural effusion, pernicious anemia and iron deficiency, lung emphysema, bronchitis, ischialgia, Bright disease of the kidney, hepatic cancer, acute yellow atrophy of the liver, cystovarium, ectopic kidney, and ejaculatio praecox. This broad array of diseases demonstrates once again that to be a good otologist, it is necessary to have an open mind concerning others parts of the body. Along with the different influences of his teachers, this certainly explains why Politzer reached such a high a level in otology. The last two publications in Hungarian concern otology and deal with the effect of mud ear on parts of hearing (1862) and acute suppurative otitis media (1908).

Objective: The objective of this article is to determine the safety and effectiveness of transvaginal sacrospinous ligament fixation as part of the management of pelvic support defects in a residency program. Study Design: A retrospective chart review of patients undergoing sacrospinous ligament fixation at the Division of Gynecology, Jackson Memorial Hospital, University of Miami School of Medicine, between July 1990 and December 1995, was performed. Patients with vaginal vault prolapse and uterine prolapse with documented preoperative evaluation were included in this study. Data were obtained using a detailed predetermined flow sheet. Results: A total of 160 patients was included in the study. All patients underwent right sacrospinous ligament fixation, anterior and posterior colporrhaphy, and perineorrhaphy. In addition, 31 (19%) underwent enterocele repair, 5 (3%) underwent trachelectomy, and 9 (6%) underwent Burch procedure. Complications included fever 13 (8.1%), urinary tract infection 16 (10%), blood loss requiring transfusion 7 (4.3%), sciatic neuralgia 2 (1.2%), and rectovaginal fistula 2 (1.2%). The mean follow-up was 40 months (range 18 to 78 months). The success of the operation was gauged by recurrence. Ninety-four percent of the patients had no evidence of vaginal vault prolapse on follow-up, and 85% had no recurrence of any pelvic support defect. Eleven of the 24 patients with recurrence underwent repeat surgery, whereas 13 opted for conservative management with pessaries. Conclusion: Transvaginal unilateral sacrospinous ligament fixation is a safe and successful operation for the treatment of pelvic support defect and should be an essential component in the training of gynecologic residents.

Periradicular therapy (PRT) has become popular in the treatment of lumbar radicular complaints, both primary, due to disc herniations (Group 1), and postoperative, following disc surgery (Group 2). However, hitherto reported data on 'periradicular injections' are more of a technical nature. The present study was designed to evaluate the therapeutic success of CT- versus fluoroscope-guided periradicular injections of local anaesthetics and corticoids, and to investigate the impact of imaging procedures on the results. We report on 80 patients who underwent CT-guided (n = 40) or fluoroscope-guided (n = 40) PRT for lumbar radicular irritation since April 1993. Forty patients had primary nerve root irritation due to disc protrusion, and 40 suffered from postoperative epidural fibrosis. Follow-up consisted in a clinical examination and an interview one day after each injection as well as 1 and 6 months later. Assessment was based on a score taking into account the clinical findings, the patient's complaints, and the patient's evaluation. Six months following treatment there was a significant reduction of ischialgia in both Groups 1 and 2 (p < 0.001). However, the results were significantly poorer in Group 2 (postoperative). Among the patients not operated on, those who underwent CT-guided injections had a significantly better outcome (p < 0.001). PRT had no significant influence on low back pain or pseudoradicular syndromes. The improvement of sensory disturbances achieved by both CT- and fluoroscope-guided injections in patients not previously submitted to surgery is statistically significant (p < 0.05). As compared to Group 1 (no surgery), the positive effects in patients of Group 2 were of significantly shorter duration (p < 0.05). Motor deficits were not influenced by the treatment. Long-term follow-up shows that there is no positive effect in those patients in whom the first two PRT attempts had failed. Thus, PRT represents a useful long-term therapeutic alternative for lumbar radicular syndromes, particularly when due to primary discogenic compression. CT-guided injection is superior to fluoroscope-assisted treatment for both its visualization and its longer-lasting effect.

We measured activities of dynorphin-converting enzyme (DCE), substance P endopeptidase (SPE) and angiotensin-converting enzyme (ACE) in cerebrospinal fluid (CSF) in 13 patients with rhizopathic pain from an herniated lumbar disc, in 9 patients with pain from coxarthrosis and in 11 control patients without pain. In the patients with disc hernia and coxarthrosis, another sample of CSF was analyzed 3-12 months after treatment, when pain had subsided. The DCE activity in the patients was higher than that in both the control patients and the patients with pain from coxarthrosis (nociceptive pain). Similarly, the activity of SPE was lower in the patients with herniated lumbar disc than in controls and in the patients with coxarthrosis. After treatment, the difference in activity compared to controls was lower, but still significant in patients with herniated discs. The ACE activity did not differ from controls in patients with ischialgia, while it was increased in patients with coxarthrosis. This increase also remained after arthroplasty with pain relief. In conclusion, measurements of neuropeptides may be useful for evaluating neuropathic pain.

Metastatic renal cell cancer is not exceptional in kidney cancer (30% of patients with kidneyl cancer). Its prognosis is particularly severe. However, sciatic neuralgia (sciatica) remains an exceptional revealing clinical sign of this disease. The authors report the case of a patient admitted with right sciatica as chief complain, leading to the discovery of a renal cell carcinoma. Although uncommon, renal cell carcinoma spine metastasis should be included in the differential diagnosis of back pain and sciatica.Key words: Renal carcinoma, kidney cancer, metastatic renal cell cancer, cytoreductive nephrectomy

BACKGROUND AND PURPOSE: T2 and ADC mappings are 2 quantitative MR imaging tools for assessing IVDD. This study aimed to compare these 2 measures in detecting IVDD and its age-related changes. MATERIALS AND METHODS: Thirty-seven asymptomatic volunteers and 28 patients with back pain or sciatica were examined, and their lumbar disk T2 and ADC maps were quantified via sagittal imaging protocols at 1.5T. For all participants, the Pfirrmann system was used by 2 radiologists for grading disks. T2 and ADC values in the inner portion of disks were measured, and their variances in different grades were analyzed by 1-way ANOVA testing. The ability of T2 and ADC measures to differentiate IVDD grades was compared on the basis of their ROC curves. For asymptomatic subjects, the correlations between age and the 2 MR imaging measures were assessed by the Pearson correlation test. RESULTS: Both T2 and ADC values were found to decrease with the increasing Pfirrmann grades except T2 in grade V. Significant T2 differences were seen among grades I-IV, but not between grades IV and V. There were no significant ADC differences among grades I-III. Moreover, the areas under the ROC curves differed significantly (0.95 and 0.67 for T2 and ADC, respectively). Linear regression analysis revealed that T2 yielded more significant correlation with age ( r = −0.77) than ADC did ( r = −0.37). CONCLUSIONS: T2 quantitation provides a more sensitive and robust approach for detecting and characterizing the early stage of IVDD and age-related disk changes.