An Unusual Cause of Sciatica

Servant, Chris

doi:10.1097/00007632-199810010-00019

Cited by 33 publications

(13 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sciatic hernia can also lead to abscess formation in the gluteal region, particularly after perforation of a strangulated bowel [7]. In our patient, there was a history of abscess development in the left gluteal region after an intramuscular injection in the region.…”

Section: Discussionmentioning

confidence: 63%

See 1 more Smart Citation

Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve

Chitranjan

Kandpal²,

Madhusudhan³

2010

BJR

View full text Add to dashboard Cite

ABSTRACT. Sciatic hernia is a rare condition with diverse clinical manifestations. We report a case of sciatic hernia causing sciatica, in which the diagnosis made on CT was subsequently confirmed on MRI including magnetic resonance neurography. The salient clinical and imaging features and a brief review are presented. Sciatic hernia is a rare condition that can lead to bowel obstruction, sciatica, pelvic pain, back pain or ureteric obstruction [1,2]. Clinical diagnosis of this condition is difficult. Ultrasonography and CT are the imaging modalities commonly used to diagnose sciatic hernia, although MRI can be used in cases in which entrapment of the sciatic nerve is suspected. Magnetic resonance neurography (MRN) provides high-resolution images to demonstrate entrapment of the nerve and morphological changes in the nerve [3]. Colour Doppler can be useful in surgical planning, as it can provide information regarding bowel viability. Case reportA 55-year-old woman presented with swelling in the left gluteal region and pain in the left lower limb of two years' duration. A detailed clinical history also revealed that she had an abscess in the left gluteal region following an intramuscular injection one year previously; however, at presentation there was no clinical feature suggestive of abscess. Physical examination revealed non-tender soft swelling in the left lumbar region with associated atrophy of gluteal muscles. To diagnose the nature of the gluteal mass, a CT scan of the pelvis and gluteal region was performed. The CT scan revealed herniation of the sigmoid colon through the greater sciatic foramen reaching up to the skin surface and atrophy of the gluteal muscles. Other major pelvic organs including the uterus, ureter and urinary bladder were normally located ( Figure 1). As there was atrophy of the left gluteal muscles, and because the patient had symptoms of sciatica, entrapment of the sciatic nerve by sciatic hernia was suspected. MRI of the pelvis and upper thigh with MRN was performed to confirm entrapment of the sciatic nerve. MRN was used for high-resolution imaging of the sciatic nerve and was performed on a 1.5 T scanner (Sonata, Siemens, Erlangen, Germany) using a pelvis phase-array coil. Sequence parameters included 4 mm section thickness, 0 mm intersection gap, 18-24 cm field of view, 256 6 256 matrix, and an 8-to 10 min imaging time per sequence. The patient underwent axial T 1 weighted spin echo (580/11/2-3 [TR/TE/excitations]) and axial and oblique coronal short tau inversion recovery (STIR, 5000/27/2-3; inversion time, 130 ms) sequences. Coronal oblique images were taken parallel to the course of the sciatic nerve. MRI revealed thickening and increased signal in the left sciatic nerve on STIR coronal oblique images (Figure 2). Lateral deviation and entrapment of the nerve by hernia was also noted along with atrophy of the left gluteal muscles.

show abstract

Section: Discussionmentioning

confidence: 63%

“…Various presentations of sciatic hernia could be symptoms of bowel obstruction, ureteric obstruction, pelvic pain, lower back pain or sciatica [2,5,6]. Sciatica occurs as a result of compression of the sciatic nerve by the herniated sac [2,7]. Ureteric obstruction can occur if a ureter is included in the herniated tissue.…”

Section: Discussionmentioning

confidence: 99%

Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve

Chitranjan

Kandpal²,

Madhusudhan³

2010

BJR

View full text Add to dashboard Cite

show abstract

“…[3] Patients with SH may present with diverse symptoms and signs ranging from flank, abdominal, pelvic, lower back or thigh pain to a gluteal mass [5] or with complications due to incarceration of their contents such as ureteric [6] or bowel obstruction [7]. Occasionally they may also present with symptoms of sciatica-due to sciatic nerve compression and irritation [8] and or obstructive uropathy due to ureteric herniation. [3,9].…”

Section: Discussionmentioning

confidence: 99%

Robot Assisted Laparoscopic Repair of Sciatic Hernia (RASH): A Case Report

2011

View full text Add to dashboard Cite

Sciatic hernia is a surgical rarity. One such hernia was incidentally diagnosed in a 79-year-old woman who underwent Robot assisted laparoscopic radical cystectomy for locally invasive bladder cancer. Intra-operatively, a patent hernia sac was noted in the sciatic notch. The hernia was successfully repaired during the same operation by using robot assisted laparoscopic technique. This appears to be the first robot assisted sciatic hernia repair in the world literature although it was done incidentally during another procedure. The technical descriptions of the operation are also applicable when isolated sciatic hernia repair is intended. A robot assisted laparoscopic repair is safe, feasible and well suited to the repair of sciatic hernias in women. The surgeon needs to be aware of this uncommon surgical pathology that may occur in women presenting with persistent chronic pelvic discomfort.

show abstract

“…Sciatica is defined as pain in the lower back and hip radiating down the back of the thigh into the leg and affects up to 40% of adults [25,26]. Sciatica may result from one of three physiologic abnormalities: mechanical deformation of the nerve, interruption of the nutrient supply to the nerve, or exposure to noxious substances from the inflammation of joints or discs.…”

Section: Discussionmentioning

confidence: 99%

“…Common etiologies of sciatica can further be grouped into intraspinal (herniated nucleus pulposus, central canal stenosis, degenerative hypertrophy of the facet joints, degenerative synovial cysts of the spinal canal, epidural abscesses, and primary and metastatic neoplasms) and extraspinal sources (lumbosacral involvement by retroperitoneal tumors, endometriosis, and viral infections) [27]. Unusual extraspinal etiologies of sciatica include nerve sheath tumors, sciatic hernias, intrapelvic aneurysms, and large uterine leiomyomas [24,25,28].…”

Section: Discussionmentioning

confidence: 99%

Acetabular paralabral cyst: an uncommon cause of sciatica

Mw²,

et al. 2003

Skeletal Radiol

View full text Add to dashboard Cite

The association between tears of the acetabular labrum and paralabral cysts has been well documented, and magnetic resonance imaging (MRI) has been shown to be the most accurate noninvasive method of depicting not only the normal anatomic structures of the hip, but also the common pathologic processes such as labral tears and paralabral cysts. We present the case of an acetabular paralabral cyst that resulted in clinically symptomatic compression of the sciatic nerve.

show abstract

An Unusual Cause of Sciatica

Abstract: The possibility of local pathology causing sciatic nerve compression should be considered when a patient reports sciatic leg pain, particularly if the presentation is atypical. Intestinal obstruction or the presence of a gluteal mass should suggest the possibility of a sciatic hernia.

Cited by 33 publications

References 4 publications

Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve

Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve

Robot Assisted Laparoscopic Repair of Sciatic Hernia (RASH): A Case Report

Acetabular paralabral cyst: an uncommon cause of sciatica

Contact Info

Product

Resources

About