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

Natural History- Disc prolapse and Sciatca 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 Piriformis Syndrome Spinal Stenosis Disc protrusion Synovial Cyst Tumours: Neurofibroma Infection: Abscess DVT Iliotibial band syndrome 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