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
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
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
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