Sciatic Neuropathy: Case Report and Discussion of the Literature on Postoperative Sciatic Neuropathy and Sciatic Nerve Tumors

Abstract

Sciatic nerve injury and dysfunction is not an uncommon cause of lower extremity symptoms in a musculoskeletal practice. We present the case of a man who presented with lower extremity weakness, pain, and cramps, and was initially diagnosed at an outside institution with bilateral S1 radiculopathies and recommended for spine surgery. He came to us for a second opinion. Electrodiagnostic testing revealed an isolated sciatic neuropathy and the patient was referred for imaging, which showed a sciatic nerve sheath tumor. Review of the literature on sciatic neuropathies shows that there can be many possible etiologies of sciatic nerve dysfunction, but that hip arthroplasty continues to be the leading risk factor. Sciatic nerve tumors are not commonly described in the literature and their definitive management remains unclear.Key words Sciatic nerve . Lumbar radiculopathy . Electrodiagnostics . Electromyography . Nerve tumors Case discussionThe subject is a 52-year-old man with a 16-year history of mild, intermittent low back pain who presented with a chief complaint of pain, cramps, and weakness in the left lower extremity. He complained of a 2-month history of persistent pain in the upper thigh-lower buttock region with pain radiating to the left leg, calf, and toes. His pain ranged from 6 to 9 on a 10-point scale, with worse pain when lying down, flexing, walking uphill, and bending. Pain lessened with rest and short periods of stretching. He denied any specific complaint of back pain, numbness, and changes in bowel or bladder function. He denied any constitutional symptoms.The patient had his first episode of back pain 16 years earlier, at which time he responded to a treatment of acupuncture and stretching. He had occasional recurrent symptoms but did well until 4 years ago, when he began to experience pain predominantly down the right lower limb and sciatica. He underwent a course of physical therapy and trigger point injections and his symptoms resolved. He was then relatively well until the current episode.The patient underwent electrodiagnostic testing several weeks after the onset of his presenting symptoms. As per written reports presented by the patient, abnormal spontaneous activity was detected in isolation in the right and left gastrocnemius muscles. There was no involvement of any of the proximal muscles including the paraspinal muscles. The patient was diagnosed with bilateral S1 radiculopathies. A recent magnetic resonance imaging (MRI) showed mild disk bulges and disk degeneration most pronounced at the L4/5 level, without significant foraminal or canal compromise. This study, in comparison to a study performed 4 years earlier during the patient's prior episode of right-sided sciatic complaints, showed no significant changes.Except for this main complaint, the patient's medical history was significant only for hypertension and partial amputation of the left thumb secondary to trauma. The patient had no medication allergies and was taking p.r.n. narcotic pain medications, antihypertensive pa...

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