Bone and soft tissue tumors presenting as sciatic notch dumbbell masses: A critical differential diagnosis of sciatica

AIM To study the clinical findings and characteristic features in sciatic notch dumbbell tumors(SNDTs).METHODS We retrospectively reviewed the clinical outcomes and characteristic features of consecutive cases of SNDTs(n = 8). RESULTS Buttock masses occurred in three patients with SNDT(37.5%). Severe buttock tenderness and pain at rest were observed in seven patients with SNDTs(87.5%). Remarkably, none of the patients with SNDTs experienced back pain. Mean tumor size was 8.4 ± 2.0 cm(range, 3.9 to 10.6 cm) and part of the tumor mass was detected in 2 patients in the sagittal view of lumbar magnetic resonance imaging(MRI).CONCLUSION The clinical information regarding to SNDTs is scarce. The authors consider that above mentioned characteristic findings may facilitate the suspicion of pelvic pathology and a search for SNDT by MRI or computed tomography should be considered in patients presenting with sciatica without evidence of spinal diseases.

Essentials for the Acupuncture Treatment of Radicular Sciatica

Acupuncture treatment can often produce a very good analgesic action on radicular sciatica, with quick effect, low recurrence rate and long period without attack, thus worthy of wide application in clinic.Following are the essentials for the acupuncture treatment of this disease.

Treatment of 50 Cases of Sciatica by Needling Zanzhu and Fengchi

Sciatica belongs to the category of Bizheng (arthralgia syndrome) in traditional Chinese medicine (TCM). From March 1997 to September 2000, we treated 50 cases of sciatica by needling Zanzhu (BL 2) and Fengchi (GB 20) with satisfactory therapeutic results. A report follows.

POINT PENETRATION AND DEEP PUNCTURE THERAPIES FOR SCIATICA:AN OBSERVATION ON 108 CASES

In 198 patients with sciatica, 108 cases were randomly chosen as treatment group with point penetration and deep puncture therapies by elongated needle and a group of 9O cases was received filiform needle therapy as control group. In the control group, the way of purgation by twirling the needle was used. The results showed that the total effective rate of the treatment group was 93. 52 %,while in the control group, it was 68. 89 %, X2 = 20. 46, P< 0. 01. It proved that point penetration and deep puncture therapies had better analgesic effect than that of the filifom needle.

ELECTRO-THERMAL MOXIBUSTION ON ACUPOINTS FOR TREATMENT OF 98 CASES OF SCIATICA

98 patients with sciatica are treated.by stimubting acupoints using a self-made electro-thermal moxibustion instrument.Results show that 82 cases arecured,8 improved and 5 effective,with the total effective rate of 96.9％.The temperature relesed from this instrument is adjustable.The electro-thermal moxibustion therapy is short in treatment duration and rapid in taking effect.Ithas no needling-induced pain and no side-effects,and is accepted preferably by patients.

OBSERVATION ON CLINICAL EFFECTS OF WARM NEEDLING ON 200 CASES OF SCIATICA

The author selected acupoints according to the meridian that was affected bypain and the primary symptoms to treat 200 cases of sciatica. Of thern, 152 (76. 0% ) cases werecured, 28 (14.0% ) markedly improved, 12 (6.0% ) improved and 8(4.0% ) ineffective.

DEEP INSERTION OF THE NEEDLE ATYAOYANGGUAN WITH ELECTROSTIMULATION FOR TREATMENT OF 120 CASES OF SCIATICA

<Absract> This paper reports the results of 120 cases of sciatica treated with deep insertion of theneedle at Yaoyangguan (GV 3 ) (experimental group). Another 51 cases used as control group weretreated with routine needling method. In the experimental group, the treatment was conducted 20times at most and 5 times at least. After an average of 13 times of treatment, the cured patients constituted 88. 33 % and the effective rate was 99. 16%. In the control group, the treatment was performed for 40 fimes at most, 10 times at least and 25 times on the average. The cure rate was 50. 98 %and the total effective rate 94. 12%. Comparison between the two groups showed a very significantdifference (X2 = 28. 38, P＜0.01 ) in the cure rate. It is cqncluded that deep insertion of the needle atYaoyangguan (GV 3) plus electrical stimulation is faster and stable in producing therapeutic effect.

COMBINED TREATMENT OF 100 CASES OF SCIATICA WITH ACUPUNCTURE AND POINT-INJECTION

In the present paper, 160 cases of sciatica patients were divided into combined treatmentgroup (acupuncture plus point-injection, 100 cases) and acupuncture group (control group, 60 cases).After two courses of treatment, of the 100 cases in the combined treatment group, 72 (72% ) werecured, 25 (25 % ) effective and 3 (3 % ) had no effect, with an effective rate of 97%; Of the 60 casesin the control group, 30 (50 % ) were cured, 21 (35 % ) effective and 9 (15 % ) had no effect, with aneffective rate of 85 %. Statistical analysis showed a significant difference between the two groups in effective rate (P < 0. 05). It displayed that the effect of acupuncture plus point-injection was apparentlysuperior to that of acupuncture.

106 CASES OF SCIATICA TREATED BY BLOOD LETTING AND CUPPINTG

The blood letting and cupping treatment can treat sciatica. The authors treated 106cases, of whom 76 cases were cured (71. 7%), 22 were improved (20.7%) and 8 didn’t show ef-fect (7. 6% ). The total effective rate is 92. 4%. This therapy has advantages of shorter course,less suffering, simple to practise, quick effect and less expense. It is a unique therapy and easy tobe popularized.

Acupuncture Treatment of Sciatica

Case HistoryThe patient,Peter Tschun Kert,a 28-year-oldmale player from a German orchestra,paid his ftrstvisit on December 2,1997,with the chief complaintof severe lumbar pain.The patient stated that onemonth before he got lumbar sprain while moving thefurniture in his house,which caused him severelumbar pain and motor impairment,and he had to liein bed in the following days.The pain radiated fromthe waist to the thigh,leading to difficult turning

One Hundred Cases of Sciatica Treated by Surrounding Puncture

From 1989 to 1995,the authors used the methodof surrounding puncture to treat 100 cases of sciaticaand obtained satisfactory therapeutic results asreported in the following.General DataIn the treatment group,of 100 cases,43 weremale and 57 female with the ages ranging from 15 to26 years,averaging 38 years.The duration of diseasewas from 3 days to 1.5 years,averaging 25 days.Ofthem,76 cases were spinal cord type and 24 nerveroot type;29 cases were diagnosed after CT examand 71 by lateral lumbar vertebra X-ray.

Jiedu Tongbi Tang Plus Phenytoin Sodium for Severe Acute Sciatica

Case 1: Mr. Li, a 55-year farmer from Hebeiprovince, paid his first visit on August 11, 1995. Thepatient complained of a sudden pain in the area fromhis left buttock down to the posterolateral aspect ofthe leg.

THE CT-GUIDED PERCUTANEOUS TREATMENTOF SCIATICA CAUSED BY INTERVERTEBRALDISC PROTRUSION

Objective To evaluate the effectiveness of CT-guided percutaneous treatment of intervertebraldisc protrusion causing sciatica (PTDPS). Subjects and ANt hods PTDPS were carried out on 306 patients withback or leg pain from Mar. 1993 to Dec. 1997. CT examination verified the intervertebral disc protrusion. WithCT-guidance a lumbar puncture needle of 20G was advanced to the site or sites around the affected nerve rootsand corticosteroid was injected into the subdural space. Results PTDPS were completed in all 306 patientssuccessfully. A 1-24 month follow -up was carried out on 186 cases. Of these 161 cases (86.5%) had good result, 16cases (8.6%) fair result and 9 cases (4.8%) without favorable result. Conclusion CT guided PTDPS is a safe,accurate, effective and minimally invasive method directing against the pathophysiolgy of sciatica caused byintervertebral disc protrusion. It is suitable for wider clinical application.

Dorsal Psammomatous Meningioma Revealed by Sciatica Case Report

Introduction: Meningiomas are benign tumors most localized in brain. Intraspinal meningiomas are rare and may have an intra or extradural topography. We report the case of a dorsal psammomatous meningioma revealed by sciatica. Case description: We present a 58-year-old female hospitalized for bilateral painful and disabling L5 sciatica rebellious to medical treatment and physiotherapy. At physical examination, she presented a lumbar spinal syndrome without root deficit. MRI (Magnetic Resonance Imaging) showed a borderline lumbar canal with a paramedian L4-L5 herniated disc. She undergone a first surgery a L4 decompressive laminectomy and there was no postoperative complications. The follow-up was marked by partial pain regression. Three months later, after a fall she presented low back pain and progressive worsening gait troubles. A MRI was realized and shown L3-L4, L4-L5 duct narrowing. A second surgery a L3 and L5 decompressive laminectomy was performed. The postoperative follow up was characterized by the worsening of the motor deficit to 2/5 associated with brisk osteotendinous reflexes. A medullary MRI was realized, showing an intradural but extra-medullary compressive lesion facing D1-D2. The indication of tumor removal was made and complete resection was performed. She totally recovered from the deficit and the pain. The pathology report showed a psammomatous meningioma. Conclusion: This case report emphasizes the atypical clinical presentation of spinal meningiomas and the importance of a meticulous neurological examination to avoid misdiagnosis.

Epidemiological, Clinical and Etiological Aspects of Sciatica in Hospital Setting, CNHU-HKM Cotonou

Sciatica, mostly clinical-based diagnosis, is a potentially debilitating condition as a result of disco-radicular conflict between L4 and L5 or L5 and S1. This study aims at describing the epidemiological, clinical and etiological aspects of sciatica in Hubert Koutoukou Maga Teaching Hospital (CNHU-HKM) of Cotonou. It was a prospective, descriptive and analytical study conducted in CNHU-HKM Cotonou neurology department from 1st January to 30th June 2016. The study population comprised 115 low back pain patients seen in consultation. Data collection was carried out through a standard information sheet with socio-demographic, clinical, para-clinical, etiological and therapeutic data. Epi data 3.1 was used for data entry and Stata11 for processing. Frequency of sciatica was 18.6%, with 95% CI [11.5% - 25.7%]. The study population age ranged from 29 to 73 years, with 52 ± 16 as mean value, while sex ratio was estimated at 0.6. Bilateral sciatica representing 53% was present in L5 and S1 nerve roots in 44.4% of cases. It was exacerbated in prolonged standing (24.4%) and relieved in supine position (44.3%), with paresthesia (59.1%) and intermittent radicular claudication (40.9%). Spinal osteoarthritis was the most prevalent etiology (47%). Sciatica is becoming increasing prevalent and should be regarded as problem of health concern.

Therapeutic Effectiveness of Hijama in Sciatica Pain

Hijama is an alternative mode of treatment also known as cupping therapy. It involves removal of subcutaneous stagnant blood through suction cups after making superficial incisions at particular area of the body. This study was undertaken to evaluate the efficacy of hijama in sciatica pain at Aligarh Shifa hospital. 92 patients with the history of sciatica were selected randomly between 18 - 75 years of age and hijama cups were applied generally at C7, T2 and L5/S1 vertebrae, while two cups were also applied bilaterally on L4/L5 vertebrae, four cups were additionally applied on hip joint, back of thigh, knee and calf muscle, all cups were applied thrice at an interval of 15 days between each session. The decrease in sciatic pain was assessed after three sessions of Hijama by numeric pain rating scale there was overall significant reduction in pain with 67 percent patients showing relief in pain up to varying degree. Present study suggests that hijama has been found to be effective in relieving pain and improving quality of life in majority of the patient’s, hence may be used as effective alternative tool to alleviate pain.

ACUPUNCTURE FOR 575 CASES OF SCIATICA CAUSED BY PROLAPSE OF LUMBOVERTEBRAL DISK

The sciatica caused by the prolapse of lumbovertebral disk which is a common disease is difficult to treat. During more than 20 years of the authors’ clinical practice, they’ ve received about a thousand of such patients. The observation was done on 575 cases whose data were relatively complete. The result of acupuncture was good. The report is as follows.

OBSERVATION ON TREATMENT OF SCIATICA WITH HOUDING ACUPOINT

In the present paper, the author reports the results of acupuncture of Houding (GV 19) and other acupoints selected along the meridian for treating sciatica. A total of 92 sciatica patients were randomly divided into Houding group (n=62) and control group (n=30). In Houding group, patients were treated mainly with puncturing Houding (GV 19), combined with Huantiao (GB 30) when necessary. In control group, patients were treated with Huantiao (GB 30), Yanglingquan (GB 34) or Zhibian (BL 54), Weizhong (BL 40), Chengshan (BL 57), Kunlun (BL 60), etc. which were selected along the route of meridian. Results indicated that following 10 sessions of treatment, in Houing and control groups, of the 62 and 30 cases, 44 and 15 were basically cured, 18 and 10 were improved, 0 and 5 failed in the treatment, with the total effective rates being 100% and 83,3% respectively. The therapeutic effect of Houding (GV 19) is significantly superior to that of acupoints selected along the meridian.

The Effectiveness of the Functional Magnetic Stimulation Therapy in Treating Sciatica Syndrome

Introduction: Degenerative or traumatic causes are most common in generating sciatica syndrome, which is normally treated with well-known physical therapy methods. A relatively new way of treating sciatica problems is so-called functional magnetic stimulation (FMS), whose principle is based on electromagnetic field inducing electrical field inside the body. Electrical field triggers action potential of nerve cells and that way stimulates peripheral motor nerve system. Aim: Aim of this study is to measure and estimate the effectiveness of implementing therapy with functional magnetic stimulation in regular physical treatment of sciatica syndrome. Materials and Methods: 28 male patients aged between 30 and 55 with back problem were recruited on an outpatient basis. FMS therapy was performed with TESLA Stym? device (Iskra Medical d.o.o., Slovenia) treating lumbosacral region equally on both sides of the spine. Physical examination was performed to evaluate tree parameters: the mobility of the lumbar spine in flexion and extension, together with the straight leg raise test (Lasegue sign). We estimated patients’ progress, comparing angle values of mobility from the first examination day with other examination days. Results: In FMS treated group of patients, lumbosacral flexion, extension and Lasegue test angle were significantly higher compared to day 0 on the first physical examination day (day 3) (p < 0.05). In control group such increase of a measured angle was not noticed until a second physical examination day (day 5) or a third physical examination day (day 8) (p < 0.05). Discussion: Results in this study showed that applying FMS therapy along with other standard physical therapy methods rapidly increased effectiveness of the treatment of sciatica syndrome (lat. ischialgia). It suggests that functional magnetic therapy could be suggested as a regular physical therapy method in treating this kind of pain syndromes.

揿针联合常规西药治疗坐骨神经痛的效果分析

目的:探讨揿针联合常规西药治疗坐骨神经痛的效果。方法:选取2019年1—12月中国中医科学院广安门医院南区收治的坐骨神经痛患者96例作为研究对象,按随机数字表法分为观察组和对照组,各48例。对照组采用常规西药治疗,观察组在对照组基础上加施揿针埋针治疗。比较两组疼痛情况、腰椎功能、临床疗效。结果:治疗前,两组疼痛评分比较,差异无统计学意义(P>0.05);治疗2周后、随访3个月后,两组疼痛评分均低于治疗前,且观察组低于对照组(P<0.05)。治疗前,两组腰椎功能评分比较,差异无统计学意义(P>0.05);治疗2周后、随访3个月后,两组腰椎功能评分均低于治疗前,且观察组低于对照组(P<0.05)。观察组治疗总有效率高于对照组,差异有统计学意义(P=0.021)。结论:揿针联合常规西药治疗坐骨神经痛的临床效果显著,可减轻患者疼痛,改善腰椎功能。