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Discover the most talked about and latest scientific content & concepts.

Concept: Sciatica

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OBJECTIVE: To present a group of anatomical findings that may have clinical significance. DESIGN: This study is an anatomical case report of combined lumbo-pelvic peripheral nerve and muscular variants. Setting: University anatomy laboratory. Participants: One cadaveric specimen. METHODS: During routine cadaveric dissection for a graduate teaching program, unilateral femoral and bilateral sciatic nerve variants were observed in relation to the iliacus and piriformis muscle, respectively. Further dissection of both the femoral nerve and accessory slip of iliacus muscle was performed to fully expose their anatomy. RESULTS: Piercing of the femoral nerve by an accessory iliacus muscle combined with wide variations in sciatic nerve and piriformis muscle presentations may have clinical significance. CONCLUSIONS: Combined femoral and sciatic nerve variants should be considered when treatment for a lumbar disc herniation is refractory to care despite positive orthopedic testing.

Concepts: Spinal disc herniation, Biology, Muscle, Sciatic nerve, Sciatica, Lumbar plexus, Dissection, Piriformis muscle

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Perineural inhibitors of tumor necrosis factor have recently generated intense interest as an alternative to epidural steroid injections for lumbosacral radiculopathy.

Concepts: Sciatica, Steroid, Epidural, Tumor necrosis factor-alpha

28

Abstract There is evidence that neuropathic pain component in low back pain (LBP) patients is associated with higher ratings of co-morbidities such as depression and anxiety disorders. In line with current findings the purpose of this clinical study is to examine a hypothesis regarding a relationship of neuropathic pain component, depression and other psychopathological symptoms in a specific group of LBP patients with sciatica pain. With respect to findings that depression is related to inflammatory changes and inflammatory mediators may play a role in neuropathic pain generation we have assessed also serum C-reactive protein (CRP). Results of the present study show that increased neuropathic pain component in sciatica patients is associated with elevated levels of depression, anxiety, alexithymia and serum CRP levels. In conclusion results of this study indicate that CRP levels in sciatica patients are closely associated with neuropathic pain.

Concepts: Inflammation, Spinal disc herniation, Back pain, Symptoms, Sciatica, Selective serotonin reuptake inhibitor, Abnormal psychology, C-reactive protein

28

Magnetic resonance (MR) imaging in patients with persistent low back pain and sciatica effectively demonstrates spine anatomy and the relationship of nerve roots and intervertebral disks. Except in cases with nerve root compression, disk extrusion, or central stenosis, conventional anatomic MR images do not help distinguish effectively between painful and nonpainful degenerating disks. Hypoxia, inflammation, innervation, accelerated catabolism, and reduced water and glycosaminoglycan content characterize degenerated disks, the extent of which may distinguish nonpainful from painful ones. Applied to the spine, “functional” imaging techniques such as MR spectroscopy, T1ρ calculation, T2 relaxation time measurement, diffusion quantitative imaging, and radio nucleotide imaging provide measurements of some of these degenerative features. Novel minimally invasive therapies, with injected growth factors or genetic materials, target these processes in the disk and effectively reverse degeneration in controlled laboratory conditions. Functional imaging has applications in clinical trials to evaluate the efficacy of these therapies and eventually to select patients for treatment. This report summarizes the biochemical processes in disk degeneration, the application of advanced disk imaging techniques, and the novel biologic therapies that presently have the most clinical promise.

Concepts: Time, Spinal disc herniation, Medical imaging, Nuclear magnetic resonance, Magnetic resonance imaging, Sciatica, Degenerative disc disease, Intervertebral disc

27

Piriformis syndrome is an uncommon cause of sciatica. It is frequently posttraumatic or in relation with anatomic abnormalities; its diagnosis is often difficult, and it needs the exclusion of common causes of sciatica. Piriformis syndrome caused by drug-induced myopathy in relation with use of statin has not been described before. We report the case of a 60-year-old woman with a history of dyslipidemia treated by atorvastatin since 3 years, who complained of a chronic pain in the left buttock radiating to the posterior thigh and knee that had been increasing during the previous 3 months. At physical examination, the patient has lameness at walking. The lumbar spine was not tender and had full range of motion. Findings on all radicular provocation tests were normal, and tests stretching the piriformis muscle were positive. Radiographs of the pelvis and lumbar spine were unremarkable. Magnetic resonance images of the lumbar spine and pelvis was performed, showing high signal intensity in T2-weighted sequences of the piriformis muscle. Treatment with atorvastatin was occasionally discontinued, and the patient reports an improvement of the sciatic pain. Reintroduction of atorvastatin was associated with relapse of the sciatic pain. Thus, clinical features and magnetic resonance imaging findings confirm that sciatic pain was related with piriformis myopathy as an adverse effect of statin.

Concepts: Spinal disc herniation, Causality, Magnetic resonance imaging, Sciatic nerve, Sciatica, Pelvis, Piriformis muscle, Piriformis syndrome

25

T-type channels are important contributors to the initiation and the maintenance of chronic pain states. Blocking T-type channels is therefore a possible therapeutic strategy for relieving pain. Here, we report the Cav3.2 T-type channel blocking action of a previously reported small organic molecule, KYS-05090S. This compound was able to reduce transiently expressed Cav3.2 currents with low micromolar affinity and mediated a hyperpolarizing shift in half-inactivation potential. KYS-05090S was then tested in models of acute and neuropathic pain. KYS-05090S (10 μg/10 μl delivered intrathecally) significantly reduced acute pain induced by formalin in both the tonic and inflammatory phases. Its antinociceptive effect was not observed when delivered to Cav3.2 null-mice revealing a Cav3.2-dependent mechanism. KYS-05090S also reduced neuropathic pain in a model of partial sciatic nerve injury. Those results indicate that KYS-05090S mediates a potent analgesic effect in inflammatory and neuropathic pain through T-type channel modulation, suggesting that its scaffold could be explored as a new class of analgesic compounds.

Concepts: Pain, Nociception, Sciatica, Chronic pain, Peripheral neuropathy

24

Herniated lumbar disc (HLD) is arguably the most common spinal disorder requiring surgical intervention. Although the term is fairly straightforward, the exact pathology and thus the clinical picture and natural history may vary. Therefore, it is immensely difficult to formulate universal guidelines for surgical treatment.

Concepts: Spinal disc herniation, Surgery, Vertebral column, Hernia, Sciatica, Lumbar

23

The research on artificial nerve conduits has become a focus of study in peripheral nerve reconstruction so as a possible replacement for the treatment of autologous nerve grafts in clinics. In this study, we used longitudinally oriented collagen conduit (LOCC) combined with nerve growth factor (NGF) to reconstruct long distance of sciatic nerve defects (35 mm) in adult dog model. The long term follow-up evaluation demonstrated that the LOCC/NGF conduit allowed functional and morphological nerve regeneration at the transection site of the injured sciatic nerve. Furthermore, the functional study confirmed that when NGF was loaded onto LOCC it promoted a better recovery of regenerated axons than LOCC alone. The gastrocnemius muscle mass in the LOCC/NGF group was significantly greater than in the LOCC alone group. The results indicated that when LOCC conduit combined with NGF it would provide a preferential environment for sciatic nerve regeneration. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2017.

Concepts: Muscle, Action potential, Sciatic nerve, Sciatica, Nerve, Nerve growth factor, Conduit

16

Evidence comparing the effectiveness of surgical and conservative treatment of symptomatic lumbar disc herniation is controversial. We sought to compare short-term and long-term effectiveness of surgical and conservative treatment in sciatica symptom severity and quality of life in patients with lumbar disc herniation in a routine clinical setting.

Concepts: Clinical trial, Spinal disc herniation, Hernia, Sciatica

6

Lumbar radiculopathy remains a clinical challenge among primary care clinicians in both assessment and diagnosis. This often leads to misdiagnosis and inappropriate treatment of patients resulting in poor health outcomes, exacerbating this already debilitating condition. This review evaluated 12 primary diagnostic accuracy studies that specifically assessed the performance of various individual and grouped clinical neurological tests in detecting nerve root impingement, as established in the current literature.

Concepts: Health care, Medicine, Diagnosis, Hospital, Evaluation, Neurology, Sciatica, The Current