Sciatica Causes and 4 case presentations Manoj Krishna Spinal Surgeon

Causes of Sciatica Lumbar Disc Prolapse Degenerative Disc Disease without neural compression Lateral Recess Stenosis Neurofibroma and other tumours Facet Joint Cyst Epidural Abscess Spinal Cord Tumour Piriformis Syndrome Diabetic Neuropathy Vascular Claudication Ilio-Tibial band Syndrome

Sciatica Caused by Neural Compression by Disc Prolapse 44 year old patient. 20 year history of intermittent low back pain 3 month history of severe right sided sciatica Right L5/S1 Disc Prolapse. Disc degeneration at L45 and L5/S1 Failed a course of physiotherapy. On Tramadol, Diclofenac and Paracetamol.

First line of Rx Sacral Epidural Injection. Good pain relief for 2 weeks and then symptoms recurred. Sometimes an epidural injection and nerve root block is all the patients need. This patient needed surgery I thought it was best to deal with all his pain generators in one operation- including the discs, the facet joints and the nerves. A discectomy alone would have dealt with his leg pain, but may have left him with residual back pain.

L4-S1 Posterior Lumbar Interbody Fusion done Reported significant improvement in symptoms. At 6 weeks was virtually pain free. To see this patient talking about his experience of surgery see Video Section of website video 31, in PLIF series.

Sciatica caused by referred pain from a disc without neural compression 53 year old patient. Left sided buttock pain radiating down left leg up to knee for 2 years.Recurring flare- ups. Pain aggravated on sitting. Not sleeping well Tried Physio for 7 months. On Gabapentin, Amitrptilline, Oxyxontin. Left L34 Nerve Root Block- no benefit MRI- Degenerative changes at L34. No neural compression. ?? Cause of Pain, and what are the treatment options

F=53 L34 Analgesic Discogram. Local Anesthetic and Omnipaque dye injected into the disc space. All her back and left thigh pain eased for 4 weeks. Was able to sleep comfortably for first time in 2 years

L34 Posterior Lumbar Interbody Fusion- complete relief of pain Reports complete relief of pain 4 weeks after surgery.

Messages Inflamed discs can cause referred leg pain without neural compression by irritating the sinu- vertebral nerve Mild disc degeneration can result in quite severe pain- because of inflammatory chemicals in the disc space- not seen on MRI scans Analgesic Discography- a new technique – offers a simple way to confirm the relevant disc as the pain generator Interbody fusion can then be used to treat the problem definitively.

Neurofibroma causing Radicular Pain AM.57 male. Left buttock, and leg pain for 12 months. No postural relief. Widespread Neurofibromatosis. MRI shows Neurofibroma at L34 on the left. Rxed by surgical excision. With Gadolinium

Sciatica caused by L45 Facet Joint Cyst. Severe Right sided leg pain and Low back pain Treated with decompression surgery Immediate pain relief

Sciatica Caused by Spinal Tumor and Vertebral Fracture Presents with h/o fall feb 06. c/o- right leg pain- xray #L3 Epidural and nerve root block in June 06- pain goes away. Also raised ESR=86. Diagnosed with Polymyalgia Rheumatica. Given Steroids. Serum electrophoresis: +ve Diagnosed with Multiple Myeloma. On chemotherapy. Still in Pain Vertebroplasty- relieved his pain.