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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

STUDY DESIGN: The 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 pra...

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Autores principales: Mostofi, Keyvan, Karimi Khouzani, Reza
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Spine Surgery 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404533/
https://www.ncbi.nlm.nih.gov/pubmed/25901230
http://dx.doi.org/10.4184/asj.2015.9.2.200
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author Mostofi, Keyvan
Karimi Khouzani, Reza
author_facet Mostofi, Keyvan
Karimi Khouzani, Reza
author_sort Mostofi, Keyvan
collection PubMed
description STUDY DESIGN: The 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. PURPOSE: The aim of this paper is to review the medical concept and management of sciatica pain in patients showing this discrepancy. OVERVIEW OF LITERATURE: To the best of our knowledge, this subject has not yet been discussed in the medical literature. METHODS: The medical records of 241 patients who were operated on for L5 or S1 sciatica caused by disc herniation were reviewed. RESULTS: We 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. CONCLUSIONS: The 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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spelling pubmed-44045332015-04-21 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 Mostofi, Keyvan Karimi Khouzani, Reza Asian Spine J Clinical Study STUDY DESIGN: The 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. PURPOSE: The aim of this paper is to review the medical concept and management of sciatica pain in patients showing this discrepancy. OVERVIEW OF LITERATURE: To the best of our knowledge, this subject has not yet been discussed in the medical literature. METHODS: The medical records of 241 patients who were operated on for L5 or S1 sciatica caused by disc herniation were reviewed. RESULTS: We 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. CONCLUSIONS: The 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. Korean Society of Spine Surgery 2015-04 2015-04-15 /pmc/articles/PMC4404533/ /pubmed/25901230 http://dx.doi.org/10.4184/asj.2015.9.2.200 Text en Copyright © 2015 by Korean Society of Spine Surgery http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Study
Mostofi, Keyvan
Karimi Khouzani, Reza
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404533/
https://www.ncbi.nlm.nih.gov/pubmed/25901230
http://dx.doi.org/10.4184/asj.2015.9.2.200
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