Abstract
41 patients with clinical features of discogenic sciatica during the last 25 years, proved later on by investigations and imaging to be a nondiscogenic in origin, The aim of the study is to inform spinal surgeons of possible differential diseases that mimic discogenic sciatica. All patients present clinically with a sciatica. They were recorded and treated accordingly and sent for investigations. Patients proved to have discogenic sciatica were excluded. Others further investigated and followed until finding a cause for the symptoms and recorded as nondiscogenic sciatica syndrome. 22 individual aetiologies were found to cause nondiscogenic including infectious, traumatic, oncogenic, degenerative, metabolic and ischemic causes. In conclusion a proper history and thorough physical examination, in addition to imaging and investigations were very useful in detecting the exact etiology of sciatica. The pain pattern and the related clinical features were the guide for the diagnosis. High index of suspicion is vital to achieve the definite diagnosis to avoid missing the diagnosis of nondiscogenic sciatica. One should maintain a high index of suspicion in patients with intractable sciatica. Keywords: [Nondiscogenic Sciatica syndrome, pseudosciatica, spine surgery, radicular pain.]
Highlights
Sciatica is a syndrome characterized by pain radiating from back to the buttock and lower extremity along its posterior or lateral aspect and it is frequently caused by lumbar disc herniation
Nondiscogenic sciatica is rare and many clinicians do not have a high index of suspicion
Visualization of the lumbosacral plexus in its entirety is difficult with the conventional twodimensional MRI sequence owing to its oblique orientation as reported by Ailianou et al.[6] they utilized threedimensional Short tau inversion sequences and different flip angles with contrast to detect lesion in the lumbosacral plexus. New modalities exist such as diffusion tensor imaging (DTI) which help in thorough exploration of even fine anatomical structures
Summary
Sciatica is a syndrome characterized by pain radiating from back to the buttock and lower extremity along its posterior or lateral aspect and it is frequently caused by lumbar disc herniation. The nondiscogenic sciatica in our series presented with the same clinical features, but the cause was not disc prolapse. Clinicians are usually familiar with discogenic causes of sciatica. What makes the diagnosis more difficult are the findings of false positive MRI findings which can be reported in asymptomatic patients. Dudeney et al.[1] Reported in 20% of sciatica is due to discogenic and nondiscogenic cause. We confirmed this finding in our report in this article with one case of a lady with dual pathology with a disc prolapse and tumor of the lumbar root. The diagnosis of sciatica cannot be decided on MRI findings alone and correlation with the clinical findings is always required. Spinal MRI scans may reveal a high rate of abnormal signs in asymptomatic individuals who do not suffer from back pain
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