Clinical findings and electrodiagnostic testing in 108 consecutive cases of lumbosacral radiculopathy due to herniated disc

Mondelli, Mauro; Aretini, Alessandro; Arrigucci, Umberto; Ginanneschi, Federica; G, Greco; Sicurelli, Francesco

doi:10.1016/j.neucli.2013.05.004

Cited by 29 publications

(23 citation statements)

References 44 publications

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“…Over the years, these contradictory results prompted us to not request EMG systematically, to avoid it progressively, and to give preference to clinical signs other than in exceptional cases. Mondelli et al [ 13 ] found abnormal results on EMG in at least one muscle supplied by femoral and sciatic nerves in 42% of patients with sciatica.…”

Section: Discussionmentioning

confidence: 99%

Reliability of the Path of the Sciatic Nerve, Congruence between Patients' History and Medical Imaging Evidence of Disc Herniation and Its Role in Surgical Decision Making

Mostofi¹,

Khouzani

2015

Asian Spine J

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Study DesignThe prevalence of disc herniation is estimated to be about 100,000 new cases per year in France and disc herniation accounts for 25% to 30% of surgical activity in Departments of Neurosurgery. Classically, sciatica is expected to follow its specific dermatome-L5 or S1-. In clinical practice, we regularly encounter patients showing discrepancy between clinical sciatica and imaging findings.PurposeThe aim of this paper is to review the medical concept and management of sciatica pain in patients showing this discrepancy.Overview of LiteratureTo the best of our knowledge, this subject has not yet been discussed in the medical literature.MethodsThe medical records of 241 patients who were operated on for L5 or S1 sciatica caused by disc herniation were reviewed.ResultsWe found an apparent clinicoradiological discrepancy between sciatica described by patients on one side and magnetic resonance imaging (MRI) finding on the other side in 27 (11.20%) patients. We did not find any other abnormalities in the preoperative and postoperative period. All of these patients underwent lumbar discectomy via posterior interlaminar approach. Three months after surgery, 25 patients (92.59%) had been totally relieved of sciatica pain. Two patients (7.41%) continued to experience sciatica in spite of the surgery.ConclusionsThe discrepancy between clinical sciatica and disc herniation level on MRI is not rare. Management of this discrepancy requires further investigation in order to avoid missing the diagnosis and treatment failure.

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Section: Discussionmentioning

confidence: 99%

Reliability of the Path of the Sciatic Nerve, Congruence between Patients' History and Medical Imaging Evidence of Disc Herniation and Its Role in Surgical Decision Making

Mostofi¹,

Khouzani

2015

Asian Spine J

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“…Normal electrophysiologic findings do not eliminate the possibility of radiculopathy. 13,14 Leriche syndrome, which is a form of internal iliac artery stenosis, can result in buttock and thigh pain. In patients with vascular claudication, symptoms typically are relieved with standing alone and may be located below the knees.…”

Section: Diagnostic Testsmentioning

confidence: 99%

Differentiating Hip Pathology From Lumbar Spine Pathology: Key Points of Evaluation and Management

Buckland

Miyamoto

Patel

et al. 2017

J Am Acad Orthop Surg

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The diagnosis and treatment of patients who have both hip and lumbar spine pathologies may be a challenge because overlapping symptoms may delay a correct diagnosis and appropriate treatment. Common complaints of patients who have both hip and lumbar spine pathologies include low back pain with associated buttock, groin, thigh, and, possibly, knee pain. A thorough patient history should be obtained and a complete physical examination should be performed in these patients to identify the primary source of pain. Plain and advanced imaging studies and diagnostic injections can be used to further delineate the primary pathology and guide the appropriate sequence of treatment. Both the surgeon and the patient should understand that, although one pathology is managed, the management of the other pathology may be necessary because of persistent pain. The recognition of both entities may help reduce the likelihood of misdiagnosis, and the management of both entities in the appropriate sequence may help reduce the likelihood of persistent symptoms.

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“…106 Electrodiagnostics can complement the findings of diagnostic imaging studies 107,108 and are particularly useful in the following 2 clinical scenarios: (1) physical examination does not correlate with imaging studies and (2) to clarify the functional significance of an imaging abnormality. 106 Previous studies 109,110 have found a sensitivity ranging between 40% and 85% in detecting lumbosacral radiculopathy, depending on the reference standard. However, electrodiagnostic tests are timesensitive because nerve root abnormalities may not be reliably detectable until 3 weeks after the onset of symptoms.…”

Section: Electrodiagnosticsmentioning

confidence: 99%

Evaluation and Treatment of Low Back Pain

Hooten

Cohen

2015

Mayo Clinic Proceedings

111

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Low back pain (LBP) is a leading cause of disability worldwide. In the absence of a classification system for pain syndromes, classification of LBP on the basis of the distribution of pain as axial (pain generally localized to the low back) or radicular neuropathic (pain radiating to the lower extremities) is relevant to clinical practice because the distribution of pain is often a corollary of frequently occurring disease processes involving the lumbar spine. Common sources of axial LBP include the intervertebral disc, facet joint, sacroiliac joint, and paraspinal musculature, whereas common sources of radicular pain include a herniated intervertebral disc and spinal stenosis. The accuracy of historical and physical examination findings has been established for sacroiliac joint pain, radiculopathy, and lumbar spinal stenosis. However, the accuracy of similar data, so-called red flags, for identifying the underlying medical sources of LBP has been overstated. Diagnostic imaging studies can be useful, and adherence to established guidelines can protect against overuse. Multiple pharmacological trials exist for the management of LBP; however, the long-term outcomes of commonly used drugs are mixed. For carefully selected patients with axial LBP, radiofrequency denervation techniques can provide sustained pain relief. In patients with radicular pain, transforaminal epidural steroid injections may provide short-term pain relief, but neurostimulation may confer more enduring benefits of refractory symptoms. Pain-related indications for commonly performed operations include spinal decompression for radicular symptoms as well as spinal fusion or disc prosthesis for discogenic LBP. Physical modalities and psychological treatments can improve pain and functioning, but patient preferences may influence treatment adherence.

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Clinical findings and electrodiagnostic testing in 108 consecutive cases of lumbosacral radiculopathy due to herniated disc

Cited by 29 publications

References 44 publications

Reliability of the Path of the Sciatic Nerve, Congruence between Patients' History and Medical Imaging Evidence of Disc Herniation and Its Role in Surgical Decision Making

Reliability of the Path of the Sciatic Nerve, Congruence between Patients' History and Medical Imaging Evidence of Disc Herniation and Its Role in Surgical Decision Making

Differentiating Hip Pathology From Lumbar Spine Pathology: Key Points of Evaluation and Management

Evaluation and Treatment of Low Back Pain

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