Influence of low back pain and prognostic value of MRI in sciatica patients in relation to back pain

Background: Patients with sciatica frequently complain about associated back pain. It is not known whether there are prognostic relevant differences in Magnetic Resonance Imaging (MRI) findings between sciatica patients with and without disabling back pain. Methods: The study population contained patients with sciatica who underwent a baseline MRI to assess eligibility for a randomized trial designed to compare the efficacy of early surgery with prolonged conservative care for sciatica. Two neuroradiologists and one neurosurgeon independently evaluated all MR images. The MRI readers were blinded to symptom status. The MRI findings were compared between sciatica patients with and without disabling back pain. The presence of disabling back pain at baseline was correlated with perceived recovery at one year. Results: Of 379 included sciatica patients, 158 (42%) had disabling back pain. Of the patients with both sciatica and disabling back pain 68% did reveal a herniated disc with nerve root compression on MRI, compared to 88% of patients with predominantly sciatica (P,0.001). The existence of disabling back pain in sciatica at baseline was negatively associated with perceived recovery at one year (Odds ratio [OR] 0.32, 95% Confidence Interval 0.18-0.56, P,0.001). Sciatica patients with disabling back pain in absence of nerve root compression on MRI at baseline reported less perceived recovery at one year compared to those with predominantly sciatica and nerve root compression on MRI (50% vs 91%, P,0.001). Conclusion: Sciatica patients with disabling low back pain reported an unfavorable outcome at one-year follow-up compared to those with predominantly sciatica. If additionally a clear herniated disc with nerve root compression on MRI was absent, the results were even worse. Copyright

Clinical diagnostic model for sciatica developed in primary care patients with low back-related leg pain

Background Identification of sciatica may assist timely management but can be challenging in clinical practice. Diagnostic models to identify sciatica have mainly been developed in secondary care settings with conflicting reference standard selection. This study explores the challenges of reference standard selection and aims to ascertain which combination of clinical assessment items best identify sciatica in people seeking primary healthcare. Methods Data on 394 low back-related leg pain consulters were analysed. Potential sciatica indicators were seven clinical assessment items. Two reference standards were used: (i) high confidence sciatica clinical diagnosis; (ii) high confidence sciatica clinical diagnosis with confirmatory magnetic resonance imaging findings. Multivariable logistic regression models were produced for both reference standards. A tool predicting sciatica diagnosis in low back-related leg pain was derived. Latent class modelling explored the validity of the reference standard. Results Model (i) retained five items; model (ii) retained six items. Four items remained in both models: below knee pain, leg pain worse than back pain, positive neural tension tests and neurological deficit. Model (i) was well calibrated (p = 0.18), discrimination was area under the receiver operating characteristic curve (AUC) 0.95 (95% CI 0.93, 0.98). Model (ii) showed good discrimination (AUC 0.82; 0.78, 0.86) but poor calibration (p = 0.004). Bootstrapping revealed minimal overfitting in both models. Agreement between the two latent classes and clinical diagnosis groups defined by model (i) was substantial, and fair for model (ii). Conclusion Four clinical assessment items were common in both reference standard definitions of sciatica. A simple scoring tool for identifying sciatica was developed. These criteria could be used clinically and in research to improve accuracy of identification of this subgroup of back pain patients

The clinical features of the piriformis syndrome: a systematic review

Piriformis syndrome, sciatica caused by compression of the sciatic nerve by the piriformis muscle, has been described for over 70 years; yet, it remains controversial. The literature consists mainly of case series and narrative reviews. The objectives of the study were: first, to make the best use of existing evidence to estimate the frequencies of clinical features in patients reported to have PS; second, to identify future research questions. A systematic review was conducted of any study type that reported extractable data relevant to diagnosis. The search included all studies up to 1 March 2008 in four databases: AMED, CINAHL, Embase and Medline. Screening, data extraction and analysis were all performed independently by two reviewers. A total of 55 studies were included: 51 individual and 3 aggregated data studies, and 1 combined study. The most common features found were: buttock pain, external tenderness over the greater sciatic notch, aggravation of the pain through sitting and augmentation of the pain with manoeuvres that increase piriformis muscle tension. Future research could start with comparing the frequencies of these features in sciatica patients with and without disc herniation or spinal stenosis

Treatment of Sciatica Following Uterine Cancer with Acupuncture: A Case Report.

For women, gynaecological or obstetrical disorders are second to disc prolapse as the most common cause of sciatica. As not many effective conventional treatments can be found for sciatica following uterine cancer, patients may seek assistance from complementary and alternative medicine. Here, we present a case of a woman with severe and chronic sciatica secondary to uterine cancer who experienced temporary relief from acupuncture

A BIRD’S EYE VIEW ON AHARAJA NIDANAS IN GRIDHRASI

Gridhrasi (Sciatica) is one among the Natamaja vata vyadhis. It is most commonly seen in the society as an eminent problem. The patient is unable to perform his daily routine activity easily. Symptoms seen are Toda (pain), initially affects Sphik (gluteal region) as well as the posterior aspects of the Uru (thigh), Janu (knee), Jangha (calf) and Pada (foot). Though Gridhrasi (Sciatica) is the Vata Vyadhi but Kapha is the Anugata Dosha. So it is classified into 2 types, Vataja and Vata-Kaphaja. Gridhrasi (Sciatica) is one among the severe debilitating disease. Acharaya Sushruta mentioned most of the Hetus (etiology) for Gridhrasi (Sciatica) from which Vata Vaigunya is important to cause disease. Vata is the main culprit in this disease and other Dosha may be involved. Gridhrasi is more common among 30 to 50 years of age group. Gridhrasi (Sciatica) can be correlated with Sciatica in contemporary science. Sciatica is the name given to pain caused by irritation of the sciatic nerve. The sciatic nerve is the longest and widest nerve in the human body. It runs from the lower back, through the buttocks, and down the legs, ending just below the knee. In the present article it’s been highlighted regarding the disease Gridhrasi and its Aharaja Nidanas (dietetic causative factors) as per the scattered references available in the various classical texts

Disc disease: A summary and review

A review of the etiology, clinical, radiological and laboratory presentation, differential diagnosis and management goals of disc disease is presented. Keywords: Disc disease, disc herniation, disc bulge, disc prolapse, disc lesion, internal disc disruption, annular tear, chemical radiculitis, low back pain, sciatica, chiropracti

An Observational study to evaluate the effect of Vaitarana Basti in the management of Vatakaphaja Gridhrasi vis-à-vis Sciatica

Sciatica refers to the low back pain radiating to lower limb in a dermatomal distribution. Sciatica is a common cause of pain and disability; it is more persistent and severe than low back pain. Sciatica prevalence from different studies ranged from 1.2% to 43%. Physical activity at work and occupational workload, such as lifting, work related twisting of the trunk, occupational exposure to whole body vibration for example machine operators, motor vehicle drivers have also been suggested to be risk factors for Sciatica. Obesity has previously been linked to Sciatica. All these factors create pressure on spinal cord producing low back ache and radiating pain. Signs and Symptoms of Sciatica shows close resemblance with Gridhrasi. In Ayurveda, Acharya Vangasena has mentioned Vaitarana Basti in the management of Gridhrasi. Vaitarana Basti adopted here in this study has a direct reference for Gridhrasi in Vangasena samhita and Acharya Chakradutta while mentioning Vaitarana Basti has indicated it in Shula, Vatakaphaja vikaras. Considering the ingredients, it is a Shodhana, Teekshna type of Basti which is beneficial in Vatakaphaja Gridhrasi. A minimum of 20 subjects who fulfilled the diagnostic and inclusion criteria were subjected to the intervention. The overall results in the study revealed statistically highly significant result

Influence of Nerve Flossing Technique on acute sciatica and hip range of motion

Background: Sciatica is one of the most common painful and disabling conditions affecting about 40% of low back pain cases and 1.6% - 43% of adult population annually. Many conventional physiotherapeutic modalities have been used to manage sciatica but the effect of Nerve Flossing Technique (NFT), which is a cost effective treatment option in the management of acute sciatica is yet to be investigated. Aim: This study was therefore conducted to investigate the influence of NFT on acute sciatica symptoms and hip range of motion. Methods: A pretest-posttest control experimental design, involving 32 participants from two hospitals in Lagos state Nigeria, with acute sciatica were randomly assigned into two groups; Group A (Study Group) received NFT in addition to Conventional Physiotherapy and group B (Control Group) received only Conventional Physiotherapy. The outcome of the study was assessed using Numeric Pain Rating Scale (NPRS) and Passive Straight Leg Raise (PSLR). Results: The result of this study revealed that, both groups were found to have significant improvement in NPRS score (P<0.01) and PSLR value (P<0.01). However, the study group had significant (P<0.01) improvement in both outcome measures when compared to the control group. Conclusion: Nerve Flossing Technique reduced acute sciatica and improved hip range of motion hence, can be utilised in the treatment of patient with acute sciatica.Key words: Nerve Flossing Technique, acute sciatica, conventional physiotherapy, hip range of motion, Numeric Pain Rating Scale, intraneural edem

MANAGEMENT OF GRIDHRASI W.S.R TO ACUTE SCIATICA THROUGH PANCHAKARMA TREATMENT

Gridhrasi or sciatica in modern language is one the common condition of loco motor system disorder; it is a pain dominant disease and reduces human activity. In Ayurveda texts it comes under Vatavyadhi. Aim: To successfully manage acute case of sciatica through Panchakarma treatment. Materials and Methods- An acute case of sciatica was taken under consideration and was given Panchakarma therapies like Kati Basti, Abhyanga, Matra Basti for 23 days. Results and conclusion: The patient got 83.3% improvement in SLR test and nerve discomfort. It was noted that Panchakarma therapy is highly effective in treating acute cases of sciatica