1/41. sciatic neuropathy secondary to a uterine fibroid: a case report.Lesions of the sciatic nerve outside the pelvis have been well described. Lesions within the pelvis, however, are far less common. We report the case of a 55-yr-old woman with a history of chronic low back pain who presented with progressive right buttock and posterolateral right lower limb pain associated with right foot numbness and tingling. She denied any associated low back or left lower limb pain. The patient was initially treated for a probable right lumbosacral radiculopathy, without improvement. A subsequent magnetic resonance image of the lumbosacral spine revealed multilevel disc degeneration at L3-4 through L5-S1, without disc herniation or canal stenosis. A magnetic resonance image of the pelvis revealed a markedly enlarged uterus, with a large pedunculated myoma impinging on the right sciatic foramen. The patient underwent a subtotal abdominal hysterectomy, with resolution of her right lower limb pain. This case illustrates the importance of considering intrapelvic causes of sciatic neuropathy. To our knowledge, this is the first reported case of sciatic neuropathy secondary to a uterine fibroid.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
2/41. Nerve root herniation secondary to lumbar puncture in the patient with lumbar canal stenosis. A case report.STUDY DESIGN: A very rare case of nerve root herniation secondary to lumbar puncture is reported. OBJECTIVE: To describe the characteristic clinical features of this case and to discuss a mechanism of the nerve root herniation. SUMMARY OF BACKGROUND DATA: There has been no previous report of nerve root herniation secondary to lumbar puncture. methods: A 66-year-old woman who experienced intermittent claudication as a result of sciatic pain on her right side was evaluated by radiography and magnetic resonance imaging, the results of which demonstrated central-type canal stenosis at L4-L5. The right sciatic pain was exacerbated after lumbar puncture. myelography and subsequent computed tomography showed marked stenosis of the thecal sac that was eccentric to the left, unlike the previous magnetic resonance imaging finding. RESULTS: At surgery, a herniated nerve root was found through a small rent of the dorsocentral portion of the thecal sac at L4-L5, presenting a loop with epineural bleeding. The herniated nerve root was put back into the intrathecal space, and the dural tear was repaired. CONCLUSION: Lumbar puncture can be a cause of nerve root herniation in cases of lumbar canal stenosis. The puncture should not be carried out at an area of stenosis.- - - - - - - - - - ranking = 8keywords = herniation (Clic here for more details about this article) |
3/41. sciatica caused by cervical and thoracic spinal cord compression.STUDY DESIGN: Two case reports of sciatica that was considered to be caused by cervical and thoracic spinal cord compression. OBJECTIVES: To point out that sciatica can be an initial major symptom in patients with cervical or thoracic spinal cord lesions. SUMMARY OF BACKGROUND DATA: Usually, tract pain caused by cord compression is considered to be diffuse and does not resemble sciatica. methods: Medical history, physical findings, and the results of imaging studies were reviewed in one case of cervical cord tumor and one case of thoracic kyphosis. RESULTS: In both cases, sciatica was the initial and major symptom. Imaging studies showed no lesion in the lumbar spine. In one patient, a cervical dumbbell tumor was found to compress the cervical cord, and in the other the spinal cord was severely compressed at the thoracic kyphosis. The sciatica disappeared immediately after decompression surgery in both cases. CONCLUSIONS: leg pain resembling sciatica can be caused by cord compression at the cervical and thoracic level. Thoracic kyphosis may be a causative factor in sciatica, in addition to spinal cord tumor and disc herniation, which have been reported previously.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
4/41. diagnosis of herniated intervertebral disc assisted by 3-dimensional, multiaxial, magnetic resonance imaging.Magnetic resonance (MR) imaging with multiaxial cross sections has been used to improve the resolution of small, fine, and slender spinal roots to more precisely diagnose herniated intervertebral disc (HIVD), especially in cases of far lateral disc (FLD) herniation. However, false-negative results remain a problem because of the unsatisfactory resolution of these methods. We report the use of a volume visualization technique to generate three-dimensional (3D) images from multiaxial sections. In our study, 10 patients with FLD herniation each underwent MR imaging (method 1), 3D MR image reconstruction with single-axis cross-sections (method 2), and 3D MR image reconstruction with multiaxial cross sections (method 3). Final diagnoses were confirmed at surgery. The preoperative diagnosis matched the operative findings in five patients using method 1, six patients using method 2, and nine patients using method 3. In addition, the software developed for this application includes functions which simulate decompression of the spinal cord and roots. Therefore, this computer-aided diagnosis system using multiaxial cross sections is a useful tool for diagnosing HIVD and for training medical residents and students. This technique has three main advantages over conventional imaging modalities: 1) resolution of small, fine, or slender anatomic structures, which reduces the possibility of false-positive and false-negative image findings; 2) segmentation (disarticulation) of images; and 3) simulation of surgery.- - - - - - - - - - ranking = 2keywords = herniation (Clic here for more details about this article) |
5/41. A migrated lumbar disc herniation simulating a dumbbell tumor.We report a case of a migrated lumbar disc hemiation, which on magnetic resonance imaging (MRI) simulated a dumbbell tumor in a 44-year-old woman who had severe pain in her right buttock and leg. A large epidural mass mimicking a dumbbell tumor was detected at the L5 vertebral level by MRI and computed tomography over myelography. Surgical fenestration of the L4/L5 interlaminar space revealed a dorsolateral epidural mass connected to the L5/S1 intervertebral disc extending laterally through the right L5/S1 intervertebral foramen. Histologically, it was degenerative disc material without active inflammation. Reevaluation of the MRI suggested some clues that might be useful in differentiating such a herniated disc from an epidural tumor.- - - - - - - - - - ranking = 4keywords = herniation (Clic here for more details about this article) |
6/41. sciatica in the community--not always disc herniation.Three cases of sciatica seen in general practice are described. The clinical features were consistent with pyriformis syndrome, a condition of compression of the sciatic nerve at the pelvic outlet. The literature on causes and clinical features is briefly reviewed. The prevalence of the condition in the community and the accuracy of clinical diagnosis are unknown. It is suggested that pelvic outlet syndrome, comparable to carpal tunnel syndrome, is a more appropriate name for the condition.- - - - - - - - - - ranking = 4keywords = herniation (Clic here for more details about this article) |
7/41. Primary pelvic hydatid cyst: an unusual cause of sciatica and foot drop.STUDY DESIGN: A case report of primary pelvic hydatid cyst causing sciatica and foot drop. OBJECTIVE: To document the occurrence of primary pelvic hydatid cyst as one of the hidden causes of lower limb weakness and foot drop, and to recommend inclusion of the pelvic cavity when assessing sciatica and foot drop. SUMMARY OF BACKGROUND DATA: It is common to see foot drop caused by peripheral lesions around the knee or disc herniation in the lumbar spine, but if these sites were excluded, the pelvic cavity must be examined for hidden disease that may explain the cause of foot drop and sciatica. methods: The authors involved in the care and management of this patient were interviewed and all medical records, radiologic investigations, and related literature were reviewed. RESULTS: After exclusion of spinal and peripheral causes of foot drop, computed tomography of the pelvis showed a well-localized cystic swelling in the right side of the pelvis over the lumbosacral plexus roots. Surgical excision of the cyst resulted in partial recovery of the foot drop at 3 years of follow-up. CONCLUSION: Primary pelvic hydatid cyst rarely causes pressure on the lumbosacral plexus. This was a case of hydatid cyst in the pelvis causing sciatica and foot drop, and it indicates the pelvis as a hidden source of sciatica and foot drop. After surgical excision followed by 4 months' mebendazole therapy, there was no evidence of recurrence on long-term follow-up.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
8/41. Fibrous adhesive entrapment of lumbosacral nerve roots as a cause of sciatica.STUDY DESIGN: Report of seven patients with fibrous adhesive entrapment of lumbosacral nerve roots as a cause of sciatica, whose radiographic findings were negative and who experienced relief from sciatica immediately after the entrapment was released. OBJECTIVES: To describe a new clinical entity of fibrous adhesive entrapment of lumbosacral nerve roots with negative radiographic findings. SETTING: Orthopaedic department, japan. methods: Clinical evaluation and post-operative outcome in seven patients with entrapment of lumbosacral nerve roots because of fibrous adhesion confirmed intraoperatively. RESULTS: Radiographic examinations by magnetic resonance imaging (MRI), myelography, and computed tomographic (CT) myelography demonstrated neither disc herniations nor spinal stenosis in all seven patients, and differential nerve root block was effective for relieving sciatica and low back pain. We confirmed, intraoperatively, entrapment of the nerve root by fibrous adhesion, and all seven patients were relieved from sciatica and low back pain postoperatively. CONCLUSION: This study presented seven patients with sciatica caused by fibrous adhesive entrapment of lumbosacral nerve roots who underwent decompression and release of fibrous adhesion. Radiographic examinations, such as MRI, myelography and CT myelography, showed no compressive shadows and also differential nerve root block was effective for its diagnosis. This study seems to be the first report of patients with entrapment of lumbosacral nerve roots caused by fibrous adhesion, whose radiographic findings were negative.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
9/41. return to work: conducting a worksite assessment.George is a 46 year old who, at work, develops back pain with right sided sciatica. Initial findings include an absent right ankle jerk with sensory loss in the distribution of the right S1 nerve root. MRI scan confirms the diagnosis of an L5-S1 disc herniation with pressure on the right S1 nerve root. Following referral to a neurosurgeon he undergoes microdiscectomy. He is now six weeks postoperative. The scar healed well. His sciatica and ankle jerk have improved. He is now considering returning to work.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
10/41. Lumbar disc herniation in early childhood: case report and literature review.INTRODUCTION: Lumbar disc herniation is a common condition in adults, uncommon in adolescents and exceptional below the age of 10 years. CASE REPORT: We report on a 6-year-old boy who presented with low-back pain and sciatica after having sustained an injury in a rear-end automobile accident. Due to our limited experience with protruded discs in this age group, we decided to be conservative initially. However, the persistence of incapacitating pain prompted surgical treatment. Operative findings consisted of a torn annulus, attached at one end to the cartilaginous plate, which formed a major portion of the extruded L5-S1 disc. DISCUSSION: A search of the literature yielded only four cases of lumbar disc (L4-5) protrusions in patients aged 9 years or younger. The child described here is one of the youngest patients with a lumbar disc rupture to be reported in the literature, and the first with an L5-S1 traumatic herniation.- - - - - - - - - - ranking = 6keywords = herniation (Clic here for more details about this article) |
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