The Nature of Radicular Pain and Related Conditions

Wilmink, J. T.

doi:10.1007/978-3-540-93830-9_1

Cited by 4 publications

(4 citation statements)

References 44 publications

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“… 6 10 12 Newer imaging modalities such as CT and MRI have allowed an accurate preoperative diagnosis of this entity that previously could be identified only during surgery. 2 11 16 19 25 The exact etiology of spinal synovial cyst is still unclear. The proposed mechanism of formation of these cysts includes repetitive microtrauma in association with abnormal spinal motion and degenerative joint changes, which leads to rupture of the synovial membrane, herniation of the synovial fluid and cells, proliferation of mesenchymal cells, and myxoid degeneration.…”

Section: Discussionmentioning

confidence: 99%

Lumbar Intraforaminal Synovial Cyst in Young Adulthood: Case Report and Review of the Literature

Kalevski

Haritonov

Peev

2014

Global Spine Journal

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Study Design Case report. Objective Lumbar juxtafacet cysts (synovial and ganglion cysts) are a rare cause of low back and radicular leg pain. Most patients with lumbar cysts are in their sixth decade of life and have significant facet joint and disk degeneration. Lumbar synovial cysts (LSCs) are extremely rare in adolescence and young adulthood, and to our knowledge, only two pediatric cases of LSC have been reported in the literature. We aim to prove the existence of LSC in adolescent patients as a real entity that causes low back and radicular complaints and to discuss the possibility of traumatic injury as a pathogenic cause of LSC formation in adolescence. A case of an 18-year old patient with LSC is presented. We report the clinical presentation, management, outcome, and review of the literature, focusing on issues that remain debatable. Methods The case is presented together with its clinical course, the diagnostic techniques, the surgical findings, histologic results, and the treatment outcome. Results After surgical treatment, the patient's complaints were alleviated and almost no complaints were registered during the next 6 months' follow-up. Conclusions LSCs are extremely rare in adolescence, but they could be considered in the differential diagnosis in adolescent patients with low back pain and radiculopathy. Surgical removal of LSC could be considered as a treatment option to provide immediate and safe symptomatic relief.

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Section: Discussionmentioning

confidence: 99%

Lumbar Intraforaminal Synovial Cyst in Young Adulthood: Case Report and Review of the Literature

Kalevski

Haritonov

Peev

2014

Global Spine Journal

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“…In the case of type II Beaton and Anson category, there is the possibility of NP in the common peroneal nerve distribution [32], yet this is debatable [10]. The discectomy at L5/S1 level can cause the release of inflammatory mediators leading to segmental sensitization [58] of the proximal L5 and S1 nerve roots, [59] both of which innervate the PM, causing PMS [13]. The myofascial component of PMS which presents as trigger points could be a sign of central sensitization [60].…”

Section: Mechanisms Of Fbss and Pmsmentioning

confidence: 99%

Piriformis Muscle Syndrome, Post Discectomy: a Comprehensive Review of its Diagnostic Process and Management, Illustrated with the Aid of a Case Report

Schembri

2018

SN Compr. Clin. Med.

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This review, with the help of a case study, provides a detailed account of the possible biopsychosocial risk factors underlying piriformis muscle syndrome, post discectomy. The diagnostic process including imaging, nerve conduction studies, musculoskeletal examination coupled with provocation maneuvers, palpation, and the musculoskeletal differential diagnosis of buttock pain is illustrated. Reference is made to the aberrant sciatic nerve anatomy and to the myofascial component which is frequently reported to underlie piriformis muscle syndrome. Additionally, the use of validated neuropathic pain assessment tools in grading the possibility of neuropathic pain due to piriformis muscle syndrome is discussed. The prevalence and mechanisms of piriformis muscle syndrome, especially post sipnal surgery, are reviewed. Evidence-based multidisciplinary management underlying this condition is discussed. In refractory cases, treatment escalation, using intramuscular botulinum neurotoxin injection, usually yields very positive results and long-term pain resolution, as evidenced by the case study.

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“…To produce compression of the DRG against the pedicle, the annulus fibrosus must be breached laterally in a location that allows migration of extruded material upward from the disc level to the infrapedicular level (upper foraminal) level to compress the ganglion; this does occur but is uncommon. 44 As discussed, interference of NGF and/or BDNF with local sprouting 42 and the neurotrophic factor-induced modulation of synaptic transmission in the spinal cord is only possible through retrograde transport of these factors in uninjured sensory afferent axons. [45][46][47] It is thus understandable that a nerve root injury proximal to the DRG (a routine herniated disc) as compared with an injury distal to the DRG may interfere with the retrograde and anterograde transport of neurotrophic factors.…”

Section: Site Of Injury As Related To the Drg: Transport Of Neurotropmentioning

confidence: 99%

Pulsed Radiofrequency

Boxem

Huntoon

Zundert

et al. 2014

Regional Anesthesia and Pain Medicine

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Radicular pain is an important health care problem, with only limited evidence-based treatments available. Treatment selection should ideally target documented pathophysiological pathways. In herniated discs, a sequence in the inflammatory cascade can be observed that initiates and maintains increased nociceptive signal input. Inflammatory mediators including tumor necrosis factor α are released from the nucleus pulposus and the degenerating peripheral nerve, which, in turn, induces production of neurotrophins like nerve growth factor and brain-derived neurotrophic factor. Neurotrophins interfere not only with the generation of ectopic firing of nociceptive neurons in the dorsal root ganglion but also with the excitability and sensitization of neuronal transmission in the dorsal spinal horn. Radicular pain is further characterized by the electrophysiological spreading of the afferent nociceptive input over different spinal nerve roots. Both the complex pathophysiological pathways involved and the spreading of the nociceptive signal make radicular pain difficult to treat. Pulsed radiofrequency (PRF) is considered an option in treatment of radicular pain. To understand and increase the efficiency of PRF interventional treatments in radicular pain, both in vitro and in vivo studies aiming at elucidating part of the mechanism of action of PRF are described. Potential factors that may improve the efficacy of PRF treatment in radicular pain are discussed.

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The Nature of Radicular Pain and Related Conditions

Cited by 4 publications

References 44 publications

Lumbar Intraforaminal Synovial Cyst in Young Adulthood: Case Report and Review of the Literature

Lumbar Intraforaminal Synovial Cyst in Young Adulthood: Case Report and Review of the Literature

Piriformis Muscle Syndrome, Post Discectomy: a Comprehensive Review of its Diagnostic Process and Management, Illustrated with the Aid of a Case Report

Pulsed Radiofrequency

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