Sciatica Differential Diagnosis

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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. TNF Alpha Phospholipase A2 Interleukin 6 Prostaglandin E2 Matrix Metallo-proteinases Nitric Oxide. - PowerPoint PPT Presentation

Text of Sciatica Differential Diagnosis

Sciatica Differential Diagnosis

Sciatica Differential DiagnosisManoj Krishna, FRCS, MCh(Orth)Spine Surgeonwww.spinalsurgeon.com

Sensory loss patterns

What happens to the trunk shift?

Chemistry of a disc prolapseTNF AlphaPhospholipase A2Interleukin 6Prostaglandin E2Matrix Metallo-proteinasesNitric Oxide

Natural History- Disc prolapse and Sciatca. Surgery vs Conservative treatmentWeber: 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 LOADING6

Causes of Leg PainPiriformis SyndromeSpinal StenosisDisc protrusionSynovial CystTumours: NeurofibromaInfection: AbscessDVTIliotibial band syndrome

Hip ArthritisPsoas HaematomaRetroperitoneal tumourVascular ClaudicationInflammatory radiculopathyDiabetesSciatic Nerve tumoursMeralgia 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-Trendelenburgs positive

8

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

AM.57 male. Left buttock, and leg pain for 12 months. No postural relief. Widespread Neurofibromatosis. With Gadolinium

Piriformis syndrome

Sciatic Nerve Entrapment under Piriformis Muscle

Tender in buttockCant sit on buttockPassive rotation of hip is painfulEMG studiesRx- PhysioRx, Surgical release 11

Left Hip Pain Caused By L2/3 Disc Prolapse