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Differential diagnosis of intraspinal and extraspinal non-discogenic sciatica

      Abstract

      The aim of this study is to present a series of 11 patients with non-discogenic sciatica (NDS), and to review the diagnostic techniques of careful clinical and radiological examination. The cases include lumbar radicular herpes zoster, lumbar nerve root schwannoma, lumbar instability, facet hypertrophy, ankylosing spondylitis, sacroiliitis, sciatic neuritis, piriformis syndrome, intrapelvic mass and coxarthrosis. The pain pattern and accompanying symptoms were the major factors suggesting a non-discogenic etiology. Pelvic MRI and CT scans, and sciatic nerve magnetic resonance neurography were the main diagnostic tools for diagnosis of NDS. The treatment of choice depended on the primary diagnosis. Detailed physical examinations with special attention paid to the extraspinal causes of sciatica and to pain characteristics are the major components of differential diagnosis of NDS.

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      References

        • Bickels J.
        • Kahanovitz N.
        • Rubert C.K.
        • et al.
        Extraspinal bone and soft-tissue tumours as a cause of sciatica.
        Spine. 1999; 24: 1611-1616
        • Dudeney S.
        • O’Farrell D.
        • Bouchier-Hayes D.
        • et al.
        Extraspinal causes of sciatica: a case report.
        Spine. 1998; 23: 494-496
        • Kralick F.
        • Koenigsberg R.
        Sciatica in a patient with unusual peripheral nerve sheath tumors.
        Surg Neurol. 2006; 66: 634-637
        • Nishikawa T.
        • Iguchi T.
        • Honda H.
        • et al.
        Primary bone tumors of the femur presenting with spinal symptoms: a report of two cases and review of the literature.
        J Spinal Disord. 2000; 13: 360-364
        • Ortolan E.G.
        • Sola C.A.
        • Gruenberg M.F.
        • et al.
        Giant sacral schwannoma. A case report.
        Spine. 1996; 21: 522-526
        • Wong M.
        • Vijayanathan S.
        • Kirkham B.
        Sacroiliitis presenting as sciatica.
        Rheumatology. 2005; 44: 1323-1324
        • Yuksel K.Z.
        • Senoglu M.
        • Yuksel M.
        • et al.
        Brucellar spondylo-discitis with rapidly progressive spinal epidural abscess presenting with sciatica.
        Spinal Cord. 2006; 44: 805-808
        • Fishman L.M.
        • Zybert P.A.
        Electrophysiologic evidence of pirı´formis syndrome.
        Arch Phys Med Rehabil. 1992; 73: 359-364
        • Jackson R.P.
        • Cain J.E.
        • Jacobs R.R.
        • et al.
        The neuroradiographic diagnosis of lumbar herniated nucleus pulposus: II. A comparison of computed tomography (CT), myelography, CT-myelography, and magnetic resonance imaging.
        Spine. 1989; 14: 1362-1367
        • Wiesel S.W.
        • Tsourmas N.
        • Feffer H.L.
        • et al.
        A study of computer assisted tomography: I. The incidence of positive CAT scans in an asymptomatic group of patients.
        Spine. 1984; 9: 549-551
        • Akay K.M.
        • Ersahin Y.
        • Cakir Y.
        Tethered cord syndrome in adults.
        Acta Neurochir (Wien). 2000; 142: 1111-1115
        • Naderi S.
        • Akşan Ö
        • Men S.
        • et al.
        Postoperative lumbosacral instability: proposal of a new classification based on etiology.
        World Spine Journal. 2007; 2: 16-21
        • Naderi S.
        • Yucesoy K.
        • Akşan Ö
        • et al.
        Epidural brucella abscess. Report of a spinal brucellosis manifesting itself with epidural abscess.
        Neuro-orthopedics. 2000; 28: 11-15
        • Naderi S.
        • Manisali M.
        • Acar F.
        • et al.
        Factors affecting reduction in low-grade lumbosacral spondylolisthesis.
        J Neurosurg: Spine. 2003; 99: 151-156
        • Chen W.S.
        Chronic sciatica caused by tuberculous sacroiliitis. A case report.
        Spine. 1995; 20: 1194-1196
        • Parziale J.R.
        • Hudgins T.H.
        • Fishman L.M.
        The PS.
        Am J Orthop. 1996; 25: 819-823
        • Brown M.D.
        • Gomez-Marin O.
        • Brookfield K.F.
        • et al.
        Differential diagnosis of hip disease versus spine disease.
        Clin Orthop Relat Res. 2004; 419: 280-284
        • Swezey R.L.
        Overdiagnosed sciatica and stenosis, underdiagnosed hip arthritis.
        Orthopedics. 2003; 26: 173-174
        • van der Linden S.
        • van der Heijde D.
        Ankylosing spondylitis.
        in: Haris R.S. Sledge C.B. Kelly’s Textbook of Rheumatology. 6th ed. WB Saunders, Philadelphia2001: 1039-1053
        • Maksymowych W.P.
        • Landewe R.
        Imaging in ankylosing spondylitis.
        Best Pract Res Clin Rheumatol. 2006; 20: 507-519
        • Battafarano D.F.
        • West S.G.
        • Rak K.M.
        • et al.
        Comparison of bone scan, computed tomography and magnetic resonance imaging in the diagnosis of active sacroiliitis.
        Semin Arthritis Rheum. 1993; 23: 161-176
        • Geıjer M.
        • Göthın G.G.
        • Göthın J.H.
        The clinical utility of computed tomography compared to conventional radiography in diagnosing sacroiliitis. a retrospective study on 910 patients and literature review.
        J Rheumatol. 2007; 34: 1561-1565
        • Odell R.T.
        • Key J.A.
        Lumbar disc syndrome caused by malignant tumors of bone.
        JAMA. 1955; 157: 213-216
        • Richardson R.R.
        • Hahn Y.S.
        • Siqueria E.B.
        Intraneural hematoma of the sciatic nerve: case report.
        J Neurosurg. 1978; 49: 298-300
        • Koga K.
        • Osuga Y.
        • Harada M.
        • et al.
        Sciatic endometriosis diagnosed by computerized tomography-guided biopsy and CD10 immunohistochemical staining.
        Fertil Steril. 2005; 84: 1508
        • Andrews D.W.
        • Friedman N.B.
        • Heier L.
        • et al.
        Tuboovarian abscess presenting as sciatic pain: case report.
        Neurosurgery. 1987; 21: 100-103
        • Macfarlane R.
        • Pollard S.G.
        Iliac and gluteal artery aneurysms presenting as sciatica.
        J Roy Soc Med. 1988; 81: 551-553
        • Aguilera V.
        • Calvo F.
        • Nos P.
        • et al.
        Sciatica secondary to a presacral abscess as the first manifestation of Crohn’s disease.
        Gastroenterol Hepatol. 2002; 25: 505-507
        • Lewis A.M.
        • Layzer R.
        • Engstrom J.W.
        • et al.
        Magnetic resonance neurography in extraspinal sciatica.
        Arch Neurol. 2006; 63: 1469-1472
        • Ozaki S.
        • Hamabe T.
        • Muro T.
        Piriformis syndrome resulting from an anomalous relationship between the sciatic nerve and piriformis muscle.
        Orthopedics. 1999; 22: 771-772
        • Filler A.G.
        • Haynes J.
        • Jordan S.E.
        • et al.
        Sciatica of nondisc origin and piriformis syndrome: Diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment.
        J Neurosurg Spine. 2005; 2: 99-115
        • Jankiewicz J.J.
        • Hennrikus W.L.
        • Houkom J.A.
        The appearance of the piriformis muscle syndrome in computed tomography and magnetic resonance imaging. A case report and review of the literature.
        Clin Orthop Relat Res. 1991; 262: 205-209
        • Lee E.Y.
        • Margherita A.J.
        • Gierada D.S.
        • et al.
        MRI of PS.
        AJR Am J Roentgenol. 2004; 183: 63-64