Sciatica Differential
Diagnosis
Manoj Krishna, FRCS, MCh(Orth)
Spine Surgeon
www.spinalsurgeon.com
Sensory loss patterns
What happens to the trunk shift?
Chemistry of a disc prolapse
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TNF Alpha
Phospholipase A2
Interleukin 6
Prostaglandin E2
Matrix Metallo-proteinases
Nitric Oxide
Natural History- Disc prolapse and Sciatca.
Surgery vs Conservative treatment
• Weber: At 1 yr- op group better. At 4 years,
slightly better. At 10 years no difference.
• SPORT Trial: Both groups better at 2 years. Op
group slightly better
• 80% of discs show a reduction in size of 50%
or more on serial MRI/CT. The largest discs
resorb the most.
Different patterns of disc degeneration
CENTRAL DISC HERNIATION ASSOCAITED WITH MORE
CHRONICITY AND MORE BACK PAIN ON LOADING
Causes of Leg Pain
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Piriformis Syndrome
Spinal Stenosis
Disc protrusion
Synovial Cyst
Tumours: Neurofibroma
Infection: Abscess
DVT
Iliotibial band syndrome
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Hip Arthritis
Psoas Haematoma
Retroperitoneal tumour
Vascular Claudication
Inflammatory
radiculopathy
• Diabetes
• Sciatic Nerve tumours
• Meralgia Paraesthetica
Hip Arthritis can mimic Sciatica!
The hip can give you a slip !
-Anterior thigh pain
-Antalgic gait
-Positive active SLR .
-Hip rotations painful / restricted
-Trendelenburg’s positive
65. M. 12m history of moderate back and leg
pain. Present even at rest.
6.5cm diameter.
No abdominal pain.
MRI scan done for
Low Back Pain.
Needs surgical
excision and
reconstruction.
Neurofibroma causing Radicular Pain
With Gadolinium
AM.57 male. Left buttock, and leg pain for 12 months.
No postural relief. Widespread Neurofibromatosis.
Piriformis syndrome
Sciatic Nerve
Entrapment
under Piriformis
Muscle
Tender in buttock
Cant sit on buttock
Passive rotation of hip is painful
EMG studies
Rx- PhysioRx, Surgical release
Left Hip Pain Caused By L2/3 Disc Prolapse