Nondiscogenic Sciatica: What Clinical Examination and Imaging Can Tell Us?

Fernando Guedes, Guedes F, Rosana Siqueira Brown, Brown RS, Francisco José Lourenço Torrão-Júnior, Lourenço Torrão-Júnior FJ, Siquara-de-Sousa AC, Ana Caroline Siquara-de-Sousa, Pires Amorim RM, Rogério Martin Pires Amorim
World neurosurgery · 2020 · doi:10.1016/j.wneu.2019.11.083 · PMID:31760186
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This retrospective analysis of six female patients with nondiscogenic sciatica identifies extrauterine endometriosis and various tumors as etiologies, highlighting infragluteal tenderness and positive Tinel's sign as key clinical indicators.

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Abstract

OBJECTIVE: Lesions affecting the sciatic nerve (SN) can mimic lumbar radiculopathy. In patients presenting with sciatica, approximately 10% have a nondiscogenic etiology. Through neurological examination and imaging, it may be possible to confirm nondiscogenic sciatica (NDS). This study aims to present a series of 6 patients with infragluteal NDS, highlighting clinical and imaging aspects that may suggest this diagnosis. METHODS: This is a retrospective study of 6 patients treated for NDS from 2010 to 2018. The mean and median ages were 41.2 and 38.5 years, respectively, with all patients female. RESULTS: All patients presented with sciatic pain, tenderness to deep infragluteal palpation, and a positive Tinel's sign related to the SN. Four patients were referred for surgical treatment, whereas 1 underwent pharmacological therapy and 1 underwent incisional biopsy and radiotherapy. In our series, 6 different causes for NDS were diagnosed: 1 nontumorous cause: extrauterine endometriosis and 5 tumors: metastasis from rectal adenocarcinoma, low-grade sarcoma, schwannoma, high-grade sarcoma, and myxoma. CONCLUSIONS: Differentiating between discogenic and NDS can be challenging for clinicians. When patients present with sciatic pain, a Tinel's sign related to the SN elicited at the deep infragluteal region, tenderness to deep infragluteal palpation, occasionally with an SN motor deficit and imaging findings of the lumbar spine that do not justify a discogenic source, the cause should be considered nondiscogenic and they should be scheduled for magnetic resonance imaging of the gluteal and pelvic region.

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Condition tags

endometriosis

MeSH descriptors

Adenocarcinoma Endometriosis Myxoma Neurilemmoma Peripheral Nervous System Neoplasms Rectal Neoplasms Sarcoma Sciatica Adenocarcinoma Adenocarcinoma Adenocarcinoma Adult Endometriosis Endometriosis Endometriosis Female Humans Magnetic Resonance Imaging Myxoma Myxoma

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References (28)

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