1. Sciatica Differential Diagnosis
Manoj Krishna, FRCS, MCh(Orth)
Spine Surgeon

2. Sensory loss patterns

3. What happens to the trunk shift?

4. Chemistry of a disc prolapse
TNF Alpha
Phospholipase A2
Interleukin 6
Prostaglandin E2
Matrix Metallo-proteinases
Nitric Oxide

5. 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.

6. Different patterns of disc degeneration
CENTRAL DISC HERNIATION ASSOCAITED WITH MORE CHRONICITY AND MORE BACK PAIN ON LOADING

7. 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

8. 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

9. 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.

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

11. 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

12. Left Hip Pain Caused By L2/3 Disc Prolapse