Fibrous adhesive entrapment of lumbosacral nerve roots as a cause of sciatica

Abstract

Study design: Report of seven patients with ®brous adhesive entrapment of lumbosacral nerve roots as a cause of sciatica, whose radiographic ®ndings were negative and who experienced relief from sciatica immediately after the entrapment was released. Objectives: To describe a new clinical entity of ®brous adhesive entrapment of lumbosacral nerve roots with negative radiographic ®ndings. Setting: Orthopaedic department, Japan. Methods: Clinical evaluation and post-operative outcome in seven patients with entrapment of lumbosacral nerve roots because of ®brous adhesion con®rmed 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 di erential nerve root block was e ective for relieving sciatica and low back pain. We con®rmed, intraoperatively, entrapment of the nerve root by ®brous adhesion, and all seven patients were relieved from sciatica and low back pain postoperatively. Conclusion: This study presented seven patients with sciatica caused by ®brous adhesive entrapment of lumbosacral nerve roots who underwent decompression and release of ®brous adhesion. Radiographic examinations, such as MRI, myelography and CT myelography, showed no compressive shadows and also di erential nerve root block was e ective for its diagnosis. This study seems to be the ®rst report of patients with entrapment of lumbosacral nerve roots caused by ®brous adhesion, whose radiographic ®ndings were negative. Spinal Cord (2001) 39, 269 ± 273

Reduction of Leg Pain by Oxiplex Gel After Lumbar Discectomy in Patients With Predominant Leg Pain and Elevated Levels of Lower Back Pain

“…7,20,36 Epidural fibrosis and subsequent tethering of the nerve root to the disk or pedicle may also contribute to postsurgical sciatica and LBP. [37][38][39][40] However, results of clinical outcome studies attempting to correlate adhesion formation with pain have not been consistent. In addition, epidural fibrosis may contribute to enhanced sensitization of the sensory nerves in the epidural space.…”

The Role of Computed Tomography in the Presurgical Diagnosis of Foraminal Entrapment of Lumbosacral Junction

“…Sciatica improved immediately after exploration. Ido and Urushidani 10) reported similar cases. MRI, myelography, and CT myelography had demonstrated neither disc herniations nor stenosis.…”

“…These entrapments can be caused by the osteophytes on the lumbosacral spine 12) , L5 transverse process and the sacral ala (the so-called 'far-out syndrome') 16) , the lumbosacral tunnel (consisting of L5 vertebral body, the lumbosacral ligament, and the sacral ala) 13) , as well as lumbar disc herniation or stenosis. The diagnosis of these pathologic conditions is based on the neurologic symptoms and radiologic findings and can be confirmed by a selective L5 spinal root block 7,10,12) . Radiologic examinations such as CT and MRI effectively reveal a neural entrapment on the central zone.…”

Use of Temporary Implantable Biomaterials to Reduce Leg Pain and Back Pain in Patients with Sciatica and Lumbar Disc Herniation

“…Most patients with epidural fibrosis do not develop symptomatic complaints [153]. However, fibrous entrapment of nerve roots may cause sciatica as demonstrated by their release, resulting in immediate relief from sciatica [154]. The pain is thought to result from entrapment of the nerve root by fibrosis resulting in enhanced sensitization in contrast to tethering.…”