Diagnostic Features of Sciatica Without Lumbar Nerve Root Compression

Yoshimoto, Mitsunori; Kawaguchi, Satoshi; Takebayashi, Toru; Isogai, Satoshi; Kurata, Yoshiaki; Nonaka, Shinsuke; Oki, Gosuke; Kosukegawa, Ima; Yamashita, Toshihiko

doi:10.1097/bsd.0b013e31817dc46d

Cited by 34 publications

(21 citation statements)

References 15 publications

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“…They proposed that this could be explained anatomically as the sigmoid "protects" the left sacral plexus. However, when we used the same methodology, reviewed all cases they referenced, and added all cases published until the time of writing (47 new cases), 13,16,21,23,26,28,29,31,32,34,35,38,42,43,45,49,50,[53][54][55] we could not confirm their finding-there was no statistically significant difference between the left and right side. We acknowledge other possible explanations such as lymphatic or hematogenous spread, but none of these theories would explain a continuous band of EM extending from the uterus to the LSP as seen in the imaging evidence presented here.…”

Section: Limitationscontrasting

confidence: 37%

Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases

Sousa¹,

Capek

Howe

et al. 2015

FOC

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Sciatic nerve endometriosis (EM) is a rare presentation of retroperitoneal EM. The authors present 2 cases of catamenial sciatica diagnosed as sciatic nerve EM. They propose that both cases can be explained by perineural spread of EM from the uterus to the sacral plexus along the pelvic autonomie nerves and then further distally to the sciatic nerve or proximally to the spinal nerves. This explanation is supported by MRI evidence in both cases. As a proof of concept, the authors retrieved and analyzed the original MRI studies of a case reported in the literature and found a similar pattern of spread. They believe that the imaging evidence of their institutional cases together with the outside case is a very compelling indication for perineural spread as a mechanism of EM of the nerve.

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Section: Limitationscontrasting

confidence: 37%

Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases

Sousa¹,

Capek

Howe

et al. 2015

FOC

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“…L Intra-Extra P,W,S Yes (Yekeler et al, 2004) 1 Sciatic n. L n/a P,W n/a (Yoshimoto et al, 2009) 2 Sciatic n. R 1 Extra, 1 n/a 2W,2P,2S 1 Yes, 1 n/a (Zager et al, 1998) 5 3 Sciatic nn., 2 LSP, 1 femoral n.…”

Section: Perineural Spread Theory -Anatomic Explanationmentioning

confidence: 98%

Neural involvement in endometriosis: Review of anatomic distribution and mechanisms

et al. 2015

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Endometriosis (EM) is an infrequent cause of peripheral neuropathy, most commonly sciatic. Perineural spread has recently been introduced as an alternate explanation for cases of lumbosacral or sciatic nerve EM. We performed a literature review to collect all reported cases of peripheral and central nervous system EM in search of anatomic patterns of involvement; potentially to support the perineural spread theory. If available, intraneural invasion and presence of peritoneal EM were recorded. The search revealed 83 articles describing 365 cases of somatic peripheral nervous EM and 13 cases of central nervous EM. The most frequently involved site was the sacral plexus (57%, n = 211), followed by the sciatic nerve (39%, n = 140). Other nerves were reported in significantly smaller numbers. Ninety seven percent (97%, n = 355) of peripheral nerve cases presented with pain, 20% (n = 72) reported weakness and 31% (n = 114), numbness. Thirty four percent (34%, n = 38) had solely intraneural EM of which 89% (n = 33) had no peritoneal EM (percentage based on available information). In the central nervous system, the conus medullaris and/or cauda equina constituted the majority of cases with 54% (n = 7). Apart from perineural spread, other discussed mechanisms include retrograde menstruation with peritoneal seeding, hematogenous and lymphogenous spread, stem cell implantation either hematogenously or via retrograde menstruation with subsequent EM differentiation, and coelomic or Müllerian duct metaplasia. We believe this literature review supports perineural spread as an alternate mechanism for EM of nerve, particularly the subgroup with intraneural EM and without peritoneal disease.

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“…Gynaecological conditions such as ectopic endometriosis, ovarian cysts and pregnancy may result in sciatica, with a tendency to affect the right side [23]. During the late stages of pregnancy or during delivery, compression of the LSP can occur between the foetal head and the pelvic rim.…”

Section: Gynaecological Pathologiesmentioning

confidence: 99%

“…Piriformis syndrome and gynaecological conditions account for most cases of extralumbar sciatica [4,23,24,26].…”

Section: Miscellaneousmentioning

confidence: 99%

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Review of the principal extra spinal pathologies causing sciatica and new MRI approaches

Ailianou¹,

Fitsiori²,

Syrogiannopoulou³

et al. 2012

BJR

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ABSTRACT. In this paper we illustrate the principal extraspinal pathologies causing sciatica and new approaches for the study of structures such as the lumbosacral plexus (LSP). Visualisation of the LSP in its entirety is difficult with conventional twodimensional MRI sequences owing to its oblique orientation. In our institution, we have found that the utilisation of three-dimensional short tau inversion-recovery sampling perfection with application-optimised contrasts using different flip angle evolutions sequence is helpful, allowing multiplanar and maximum intensity projection reconstructions in the coronal oblique plane and curvilinear reformats through the plexus. Diffusion tensor imaging enables the observation of microstructural changes and can be useful in surgical planning. The normal anatomy of the LSP, its different extraspinal pathologies and differential diagnoses are thoroughly presented.

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Diagnostic Features of Sciatica Without Lumbar Nerve Root Compression

Abstract: Piriformis syndrome and gynecologic conditions account for most cases of extralumbar spinal sciatica. Female sex, right side involvement, and overlapping sensory disturbance are suggestive of extralumbar spinal sciatica associated with gynecologic conditions.

Cited by 34 publications

References 15 publications

Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases

Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases

Neural involvement in endometriosis: Review of anatomic distribution and mechanisms

Review of the principal extra spinal pathologies causing sciatica and new MRI approaches

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