Extra-spinal sciatica and sciatica mimics: a scoping review

Siddiq, Md Abu Bakar,Clegg, Danny,Hasan, Suzon Al,Rasker, Johannes J The Korean Pain Society 2020 The Korean Journal of Pain Vol.33 No.4

Not all sciatica-like manifestations are of lumbar spine origin. Some of them are caused at points along the extra-spinal course of the sciatic nerve, making diagnosis difficult for the treating physician and delaying adequate treatment. While evaluating a patient with sciatica, straightforward diagnostic conclusions are impossible without first excluding sciatica mimics. Examples of benign extra-spinal sciatica are: piriformis syndrome, walletosis, quadratus lumborum myofascial pain syndrome, cluneal nerve disorder, and osteitis condensans ilii. In some cases, extra-spinal sciatica may have a catastrophic course when the sciatic nerve is involved in cyclical sciatica, or the piriformis muscle in piriformis pyomyositis. In addition to cases of sciatica with clear spinal or extra-spinal origin, some cases can be a product of both origins; the same could be true for pseudo-sciatica or sciatica mimics, we simply don't know how prevalent extra-spinal sciatica is among total sciatica cases. As treatment regimens differ for spinal, extra-spinal sciatica, and sciatica-mimics, their precise diagnosis will help physicians to make a targeted treatment plan. As published works regarding extra-spinal sciatica and sciatica mimics include only a few case reports and case series, and systematic reviews addressing them are hardly feasible at this stage, a scoping review in the field can be an eye-opener for the scientific community to do larger-scale prospective research.

좌골신경통(坐骨神經痛)의 침구치료(鍼灸治療)에 관(關)한 문헌적(文獻的) 고찰(考察)

문자영 ( Ja Young Moon ),이준희 ( Jun Hee Lee ),박철진 ( Chul Jin Park ) 대한경락경혈학회 2009 Korean Journal of Acupuncture Vol.26 No.2

Objectives: This study is performed to investigate the acupuncture on Sciatica through the literature of oriental medicine. Methods: We collected the oriental medical literature from ancient to modern times, and extracted the causes, symptoms, treatments and acupoints of sciatica. Results: The findings of this study are as follows: 1. The etiology of Sciatica is differentiated into the exogenous pathogenic factors(wind, cold, dampness, trauma, bad posture) and the internal pathogenic factors(deficiency of the kidney energy, congenital debility). 2. The symptoms of Sciatica are pain, weakness and dysesthesia in the low back, hip and lower limb. 3. In the treatment of Sciatica, The Leg Greater Yang Bladder (BL) Meridian and The Leg Lesser Yang Gall Bladder (GB) Meridian out of 12 meridians were mainly used and the acupoint GB30(Hwando) was most frequently used in the acupuncture literature. 4. The number of acupoints used for sciatica was 95, and those acupoints in the order of frequency were GB30(Hwando), GB34(Yangnungch`on), BL40(Wijung), BL60(Kollyun), GB31(P`ungshi), GB39(Hyonjong), BL57(Sungsan), ST36(Chok-samni). Conclusion: The most frequently used acupoints for the treatment of sciatica are as follows; GB30(Hwando), GB34(Yangnungch`on), GB31(P`ungshi), GB39(Hyonjong) of The Leg Lesser Yang Gall Bladder Meridian, BL40(Wijung), BL60(Kollyun), BL57(Sungsan) of The Leg Greater Yang Bladder Meridian.

요각통(腰脚痛) 좌우(左右) 편재(偏在)에 따라 기혈수(氣血水) 변증(辨證)을 적용한 임상적 연구

이정호 ( Jung Ho Lee ),송미영 ( Mi Young Song ),이강수 ( Kang Su Lee ),이명종 ( Myung Jong Lee ) 한방재활의학과학회 2005 한방재활의학과학회지 Vol.15 No.3

Objectives : The aim of this study was to investigate fundamental epidemiological survey and to analyze symptoms of sciatica. Methods : 15 patients with sciatica who attended Dept. of Oriental Rehabilitation Medicine, College of Oriental Medicine, Dong-Guk University from May to June 2005, were involved in the investigation. Symptom score obtained from the comprehensive diagnosis of Qui, Xue, Shui was applied as index for imbalance of the human body. Results : Xue yu scores in 6 patients with left sciatica were higher than diagnostic score(20). Shui chih scores in 9 patients with right sciatica were higher than diagnostic score(13). Conclusions : The total score of comprehensive diagnosis of Qui Xui Shui was influenced by the laterality of sciatica. All the imbalance states of the 6 patients with left sciatica were diagnosed as Xue yu. But all the imbalance states of the 9 patients with right scaitica were diagnosed as Shui chih.

Should indications for laterally extended endopelvic resection (LEER) exclude patients with sciatica?

Hiroyuki Kanao,Yoichi Aoki,Atsushi Fusegi,Nobuhiro Takeshima 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.5

Objective: Previously, indications for laterally extended endopelvic resection (LEER) haveexcluded patients with sciatica because R0 resection has not been deemed possible [1]. Because laparoscopy optimizes visualization and thus provides for meticulous dissection, wehypothesized that R0 resection can be achieved by means of laparoscopic LEER in patientswith sciatica. This video article aimed to clarify the technical feasibility of laparoscopic LEERperformed for laterally recurrent previously irradiated cervical cancer with concomitant sciatica. Methods: We investigated technical feasibility of laparoscopic LEER performed as a salvagetherapy following abdominal radical hysterectomy and concurrent chemoradiotherapy ina patient suffering laterally recurrent cervical carcinoma with concomitant sciatica. Therecurrent tumor involved the right external and internal iliac artery and vein, ileocecum,rectosigmoid colon, right ureter, right obturator nerve, and right sciatic nerve, with aresulting fistula between the tumor and the rectosigmoid colon, and severe sciatica. Resection of all these structures was essential for achievement of R0 status, and suchresection means concomitant femoral bypass with prosthetic graft interposition andgastrointestinal/urinary tract resection. Results: Laparoscopic LEER with femoral-femoral artery bypass could be conductedwithout any postoperative complications. Pathological R0 resection could be achieved, andlocal recurrence could have been controlled. However, the patient died from liver and lungmetastasis at 1 year after this resection surgery. Conclusion: Laparoscopic LEER for a laterally recurrent previously irradiated cervical cancerwith concomitant sciatica was technically feasible, however, further study involving a greaternumber of patients and longer follow-up period is warranted to determine the stringentindications.

좌골신경통에 적용한 추나 치료에 대한 체계적 문헌 고찰 및 메타 분석

홍수민,오승준,이은정 한의병리학회 2020 동의생리병리학회지 Vol.34 No.6

This study aimed to evaluate the effects of Chuna therapy for Sciatica. We searched the following 16 online databases without a language restriction ( Pubmed, Cochrane, Embase, CINAHL, Ovid, Kmbase, RISS, NDSL, OASIS, KISS, KNAL, KTKP, DBpia, CNKI, Wangfang, J-stage) to find randomized controlled clinical trials that used Chuna therapy for Sciatica. The methodological quality of randomized controlled clinical trials (RCTs) were assessed using the Cochrane risk of bias tool and meta-analysis were performed. Among 496 articles that were searched, 15 RCTs were finally selected for systematic review. 14 studies showed that Chuna therapy has positive effect on sciatica. Two studies noted that there were side effects, and the difference between the intervention group and the control group was statistically insignificant. One study noted no side effects and the rest of the study, there was no mention of side effects. Meta-analysis showed positive results for Chuna single therapy in terms of efficiency rate compared to painkiller, herb medicine excepting acupuncture. When comparing Chuna therapy plus acupuncture and acupuncture, Chuna therapy plus acupuncture had a more positive result than acupuncture in terms of efficiency rate. Cochrane Risk of Bias (RoB)evaluation method, most of the studies's selection, performance, detection and reporting bias were unclear. The studies showed that Chuna therapy can significantly effective on sciatica. However, most of the studies’s Risk of Bias included in the analysis were not low enough. In the future, to prove the level of evidence of Chuna therapy, more high-quality studies will be needed.

좌골신경통에 대한 전침 치료: 체계적 문헌고찰 및 메타분석

김예은 ( Ye-eun Kim ),안정훈 ( Jeong-hoon Ahn ),차윤엽 ( Yun-yeop Cha ),한인식 ( In-sik Han ),허인 ( In Heo ),박인화 ( In-hwa Park ) 한방재활의학과학회 2022 한방재활의학과학회지 Vol.32 No.2

Objectives This study was conducted to evaluate the effect of electro-acupuncture for sciatica. Methods We searched 13 online databases (Kmbase, Research Information Sharing Service [RISS], National Digital Science Library [NDSL], Oriental Medicine Advanced Searching Integrated System [OASIS], Koreanstudies, Koreantk, DBpia, PubMed, Cochrane, EMBASE, Medline, China National Knowledge Infrastructure [CNKI], Jstage) to find randomized-controlled clinical trials (RCTs) that used electro-acupuncture for sciatica. Efficacy rate and visual analogue scale (VAS) were mainly analyzed as a main evaluation criteria. Results Among 583 articles that were searched, 24 RCTs were finally selected and 18 RCTs were statistically analyzed. Electro-acupuncture was more effective than acupuncture in terms of efficacy rate (p<0.00001) and VAS (p<0.00001). Also, Electroacupuncture was more effective than western medication in terms of efficacy rate (p= 0.0005). However, the effectiveness of electro-acupuncture was not identified compared to physical therapy (p=0.42). Electro-acupuncture significantly improved efficacy rate when combined with physical therapy than physical therapy alone (p<0.0001). In addition, electro-acupuncture plus Chuna manual therapy compared to Chuna manual therapy alone showed positive results for efficacy rate (p=0.05) and VAS (p <0.0001). Conclusions Based on results, the effectiveness of electro-acupuncture for sciatica was identified. However, this study has limitations because the RCTs included in this study were small in number and published in a particular region. Although this study could be a groundwork for well designed research for sciatica. (J Korean Med Rehabil 2022;32(2):105-121)

신경가동기법이 궁둥신경통 환자의 통증, 허리기능장애 및 뒤넙다리근 유연성에 미치는 영향

최영준 ( Young-jun Choi ) 한국리듬운동학회 2016 한국리듬운동학회지 Vol.9 No.1

The purpose of this study was to investigate clinical effects of nerve mobilization on pain, lumbar dysfunction, and hamstring flexibility in patients with sciatica. Twenty patients with sciatica were randomly assigned into either the nerve mobilization(NM)group or the conservative treatment(CT)group as experimental and control groups, respectively. All treatments were performed three times per week over 4 weeks. Visual analogue scale(VAS) score for pain, Oswestry Disability Index(ODI) score for lumbar dysfunction were determined and Straight leg raising(SLR) test assessment of hamstring flexibility was performed before and 4 weeks after treatment in order to directly compare the treatment effects between the groups. In the NM group, the VAS score, ODI score, and hamstring flexibility were significantly improved. Nerve mobilization treatment was effective to alleviate pain, recover functions, and reduce hamstring tension in the patients with sciatica. Hence, it might be recommended in the treatment of patients with sciatica.

Baastrup’s Disease Is Associated with Recurrent of Sciatica after Posterior Lumbar Spinal Decompressions Utilizing Floating Spinous Process Procedures

Masao Koda,Chikato Mannoji,Masazumi Murakami,Tomoaki Kinoshita,Jiro Hirayama,Tomohiro Miyashita,Yawara Eguchi,Masashi Yamazaki,Takane Suzuki,Masaaki Aramomi,Mitsutoshi Ota,Satoshi Maki,Kazuhisa Takaha 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.6

Study Design: Retrospective case-control study. Purpose: To determine whether kissing spine is a risk factor for recurrence of sciatica after lumbar posterior decompression using a spinous process floating approach. Overview of Literature: Kissing spine is defined by apposition and sclerotic change of the facing spinous processes as shown in X-ray images, and is often accompanied by marked disc degeneration and decrement of disc height. If kissing spine significantly contributes to weight bearing and the stability of the lumbar spine, trauma to the spinous process might induce a breakdown of lumbar spine stability after posterior decompression surgery in cases of kissing spine. Methods: The present study included 161 patients who had undergone posterior decompression surgery for lumbar canal stenosis using a spinous process floating approaches. We defined recurrence of sciatica as that resolved after initial surgery and then recurred. Kissing spine was defined as sclerotic change and the apposition of the spinous process in a plain radiogram. Preoperative foraminal stenosis was determined by the decrease of perineural fat intensity detected by parasagittal T1-weighted magnetic resonance imaging. Preoperative percentage slip, segmental range of motion, and segmental scoliosis were analyzed in preoperative radiographs. Univariate analysis followed by stepwise logistic regression analysis determined factors independently associated with recurrence of sciatica. Results: Stepwise logistic regression revealed kissing spine (p =0.024; odds ratio, 3.80) and foraminal stenosis (p <0.01; odds ratio, 17.89) as independent risk factors for the recurrence of sciatica after posterior lumbar spinal decompression with spinous process floating procedures for lumbar spinal canal stenosis. Conclusions: When a patient shows kissing spine and concomitant subclinical foraminal stenosis at the affected level, we should sufficiently discuss the selection of an appropriate surgical procedure.

Case Report : Large Sized Common Iliac Artery Aneurysm with Thrombus Developing a Diagnostic Confusion in a Patient with Sciatica

( Ik Chan Jeon ),( Sang Woo Kim ),( Young Jin Jung ) 대한통증학회 2014 The Korean Journal of Pain Vol.27 No.4

The causes of sciatica are variable and include musculoskeletal, dermatologic, infectious, neoplastic, and vascular disorders. In many cases, the symptom is usually caused by degenerative disease in the spine with the compression or irritation of spinal nerve. On the other hands, there are also several announced extra-spinal causes including aneurysm, diabetes, and radiation for sciatica in a low rate. Among the extra-spinal cases, aneurysms arising from iliac vessels are sometimes developing a diagnostic confusion with the spinal causes, and delayed diagnosis can lead to poor prognosis. It is very important to pay attention weather the aneurysmal cause is involved in the symptom of sciatica. (Korean J Pain 2014; 27: 360-364)

요통 환자에서 요통 및 방사통과 요추 자기공명영상의 이상소견에 대한 Tree모형의 활용

최영칠,손은주,이태용 건국대학교 의과학연구소 2002 건국의과학학술지 Vol.12 No.-

To detect the MRI findings related to The low back pain and sciatica according to age group, authors used tree model analysis of 80 patient's grading their low back pain and sciatica, with their lumbar MRI findings. And the results were as follows: 1. In teens and twenties(n=22), the low back pain was related to high maximum of spinal canal narrowing and large sum of disc degeneration, and the sciatica was related to the psoas spine ratio. 2. In thirties and forties(n=33), the sum of disc degeneration, the sum of foraminal narrowing, the maximum of disc degeneration affected the low back pain, and the sum of disc degeneration, disc herniation and maximum of canal narrowing were related to sciatica. 3. In fifties and sixties(n=23) the low back pain was related to large sum of foraminal narrowing and small psoas spine ratio, and thesciatica was largely affected by high maximum of foraminal narrowing and some by large sum of canal narrowing and large sum of disc degeneration.