Acute Sciatic Neuritis following Lumbar Laminectomy

It is commonly accepted that the common cause of acute/chronic pain in the distribution of the lumbosacral nerve roots is the herniation of a lumbar intervertebral disc, unless proven otherwise. The surgical treatment of lumbar disc herniation is successful in radicular pain and prevents or limits neurological damage in the majority of patients. Recurrence of sciatica after a successful disc surgery can be due to many possible etiologies. In the clinical setting we believe that the term sciatica might be associated with inflammation. We report a case of acute sciatic neuritis presented with significant persistent pain shortly after a successful disc surgery. The patient is a 59-year-old female with complaint of newly onset sciatica after complete pain resolution following a successful lumbar laminectomy for acute disc extrusion. In order to manage the patient’s newly onset pain, the patient had multiple pain management visits which provided minimum relief. Persistent sciatica and consistent physical examination findings urged us to perform a pelvic MRI to visualize suspected pathology, which revealed right side sciatic neuritis. She responded to the electrical neuromodulation. Review of the literature on sciatic neuritis shows this is the first case report of sciatic neuritis subsequent to lumbar laminectomy.

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Spondylolisthesis following lumbar disc surgery in a child

Journal of Neurosurgery ◽

10.3171/jns.1971.34.4.0563 ◽

1971 ◽

Vol 34 (4) ◽

pp. 563-568 ◽

Cited By ~ 3

Author(s):

Arthur Kobrine ◽

Paul C. Bucy

Keyword(s):

Intervertebral Disc ◽

Case Reports ◽

Lumbar Disc ◽

Lumbar Disc Surgery ◽

Lumbar Intervertebral Disc ◽

Related Case ◽

Content Type ◽

Disc Surgery ◽

Roentgenographic Examination ◽

Fine Print

✓ The case of a 13-year-old boy with a gelatinous, herniated lumbar intervertebral disc is reported. Roentgenographic examination 8 years following laminectomy demonstrated spondylolysis and spondylolisthesis of L-5 on S-1. Related case reports and theories are tabulated and discussed.

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Superior rectal artery injury following lumbar disc surgery

Journal of Neurosurgery Spine ◽

10.3171/spi.2001.95.1.0108 ◽

2001 ◽

Vol 95 (1) ◽

pp. 108-110 ◽

Cited By ~ 3

Author(s):

Yu-Duan Tsai ◽

Pao-Chu Yu ◽

Tao-Chen Lee ◽

Han-Shiang Chen ◽

Shih-Ho Wang ◽

...

Keyword(s):

Lumbar Disc ◽

Traumatic Injury ◽

Vena Cava ◽

Lumbar Disc Surgery ◽

Anulus Fibrosus ◽

Superior Rectal Artery ◽

Content Type ◽

Artery Injury ◽

Disc Surgery ◽

First Case

✓ Traumatic injury of the aorta, inferior vena cava, and iliac vessels due to penetration of the anterior anulus fibrosus and anterior longitudinal ligament is a recognized complication of lumbar disc surgery. The authors report, to the best of their knowledge, the first case of discectomy-related superior rectal artery injury treated by endovascular intervention.

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Prevention of recurrent radicular pain after lumbar disc surgery: a prospective study

Advanced Peripheral Nerve Surgery and Minimal Invasive Spinal Surgery - Acta Neurochirurgica ◽

10.1007/3-211-27458-8_33 ◽

2005 ◽

pp. 151-154 ◽

Cited By ~ 21

Author(s):

G. Gambardella ◽

Olga Gervasio ◽

C. Zaccone ◽

E. Puglisi

Keyword(s):

Prospective Study ◽

Lumbar Disc ◽

Radicular Pain ◽

Lumbar Disc Surgery ◽

Disc Surgery ◽

A Prospective Study

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Reoperation after lumbar intervertebral disc surgery

Journal of Neurosurgery ◽

10.3171/jns.1978.48.2.0259 ◽

1978 ◽

Vol 48 (2) ◽

pp. 259-263 ◽

Cited By ~ 110

Author(s):

Jay D. Law ◽

Ralph A. W. Lehman ◽

Wolff M. Kirsch

Keyword(s):

Lumbar Disc ◽

Leg Pain ◽

Sensory Loss ◽

Herniated Disc ◽

Lumbar Intervertebral Disc ◽

Content Type ◽

Dorsal Rhizotomy ◽

Dural Sac ◽

Disc Surgery ◽

Straight Leg Raising

✓ This retrospective study includes 53 patients who underwent reoperation after failure of lumbar disc surgery to relieve pain. All patients had leg pain before reoperation, which was successful in 28% of cases. Most clinical features, such as persistence or mode of recurrence of pain, radicular quality of pain, positive straight-leg raising, and myelographic root sleeve defects, were not helpful in predicting successful and unsuccessful reoperations. However, a significantly larger percentage of women than men had successful reoperations. Patients who had past or pending compensation claims, who had sensory loss involving more than one dermatome, or who failed to have myelographic dural sac indentations resembling those caused by a herniated disc did poorly with reoperation. A very convincing myelographic defect appears to be needed to justify reoperation at a previously unoperated location. Excision of scar alone or dorsal rhizotomy was of no avail in these cases.

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Microsurgical reoperation following lumbar disc surgery

Journal of Neurosurgery ◽

10.3171/jns.1989.70.3.0397 ◽

1989 ◽

Vol 70 (3) ◽

pp. 397-404 ◽

Cited By ~ 109

Author(s):

Uwe Ebeling ◽

H. Kalbarcyk ◽

H. J. Reulen

Keyword(s):

Lumbar Disc ◽

Time Interval ◽

Epidural Fibrosis ◽

Lumbar Intervertebral Disc ◽

Disc Protrusion ◽

Content Type ◽

Disc Surgery ◽

True Recurrence ◽

Working Capability ◽

Fine Print

✓ Ninety-two patients who underwent microsurgical reoperation for persistent or new complaints following initial lumbar intervertebral disc surgery were evaluated retrospectively. Sixty percent of all pain relapses occurred within 1 year following the first operation; thereafter, the probability of a relapse declined steadily and was as low as 0.1% per year between 5 and 20 years. The results of microsurgical reoperation in terms of pain relief and working capability were considered “excellent” in 22% of patients, “good” in 30%, and “satisfactory” in 29%. Thus, 81% of the patients could be considered as treated successfully and in 19% the result was not successful. The most common intraoperative findings were: a true recurrence at the same level in 43% of cases, a new herniation at another level in 15%, and a small recurrent fragment embedded in epidural fibrosis in 23%. Five percent of patients had severe epidural fibrosis as the only pathology. In 15%, reoperation was performed within 1 month to treat persisting pain, and either a missed disc fragment, an inadequately decompressed lateral recess, or an unrecognized second-level disc protrusion was found. The clinical outcome is affected predominantly by the intraoperative pathology and the time interval between the first and second operation. An excellent or good outcome was usually achieved in patients with a recurrence of pain after 1 year resulting from a true recurrent disc or a new herniation at another level. In contrast, very unfavorable results were noted with most reoperations performed during the 1st year when extensive epidural fibrosis (or fibrosis with a small recurrence) was present.

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Impairment Tutorial: Functionally Limiting Upper Extremity Pain: Controversies in Impairment Rating

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2003.sepoct02 ◽

2003 ◽

Vol 8 (5) ◽

pp. 4-12

Author(s):

Lorne Direnfeld ◽

James Talmage ◽

Christopher Brigham

Keyword(s):

Upper Extremity ◽

Radicular Pain ◽

Illness Behavior ◽

Orthopedic Surgeon ◽

First Case ◽

Clinical Presentations ◽

Whole Person ◽

Physical Examinations ◽

Upper Extremity Impairment ◽

The Individual

Abstract This article was prompted by the submission of two challenging cases that exemplify the decision processes involved in using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). In both cases, the physical examinations were normal with no evidence of illness behavior, but, based on their histories and clinical presentations, the patients reported credible symptoms attributable to specific significant injuries. The dilemma for evaluators was whether to adhere to the AMA Guides, as written, or to attempt to rate impairment in these rare cases. In the first case, the evaluating neurologist used alternative approaches to define impairment based on the presence of thoracic outlet syndrome and upper extremity pain, as if there were a nerve injury. An orthopedic surgeon who evaluated the case did not base impairment on pain and used the upper extremity chapters in the AMA Guides. The impairment ratings determined using either the nervous system or upper extremity chapters of the AMA Guides resulted in almost the same rating (9% vs 8% upper extremity impairment), and either value converted to 5% whole person permanent impairment. In the second case, the neurologist evaluated the individual for neuropathic pain (9% WPI), and the orthopedic surgeon rated the patient as Diagnosis-related estimates Cervical Category II for nonverifiable radicular pain (5% to 8% WPI).

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Residual complaints following lumbar disc surgery: prognostic indicators of outcome

Pain ◽

10.1016/j.pain.2004.12.021 ◽

2005 ◽

Vol 114 (1) ◽

pp. 177-185 ◽

Cited By ~ 14

Author(s):

Raymond W.J.G. Ostelo ◽

Johan W.S. Vlaeyen ◽

Piet A. van den Brandt ◽

Henrica C.W. de Vet

Keyword(s):

Lumbar Disc ◽

Lumbar Disc Surgery ◽

Prognostic Indicators ◽

Disc Surgery

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B.05 Hemi-laryngopharyngeal spasm (HELPS) syndrome: The discovery, cure, and characterization of a new neurological condition

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2017.76 ◽

2017 ◽

Vol 44 (S2) ◽

pp. S11-S11

Author(s):

C Honey ◽

M Morrison

Keyword(s):

Surgical Care ◽

Review Of The Literature ◽

The Past ◽

First Case ◽

Patient Reported ◽

Operative Outcome ◽

Small Cohort ◽

The Common ◽

Similar Motor

Background: We published the world’s first case of hemi-laryngpharyngeal spasm (HELPS) syndrome cured by microvascular decompression (MVD) of the Xth cranial nerve in 2016. We now present a small cohort of patients (n=3) successfully treated with surgery in order to better delineate the common characteristics of this syndrome, diagnostic tests of choice, nuances of their surgical care and outcomes of their treatment. Methods: The history and physical examination of three patients with HELPS syndrome are presented. Pre-operative laryngoscopy, neuroimaging, response to botox and intra-operative videos are detailed. Post-operative outcome and complications are presented. Results: Each patient reported similar motor (choking) and sensory (coughing) features in their history. Episodic choking relentlessly progressed over the years until it occurred while sleeping and with frightening severity prompting tracheostomy in one patient and intubation in another. A “tickling” sensation deep in the throat triggered episodic coughing that worsened over the years until it occurred while sleeping and with frightening severity (syncope and incontinence). Conclusions: A review of the literature suggests that patients with similar symptoms, often called episodic laryngospasm in the past, have been treated with psychotherapy or antacids. With the recognition that a clearly defined subset of these patients have HELPS syndrome, we can offer them the potential of a neurosurgical cure.

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Posterior epidural migration of sequestered lumbar disc fragments

Journal of Neurosurgery Spine ◽

10.3171/spi.1999.90.2.0264 ◽

1999 ◽

Vol 90 (2) ◽

pp. 264-266 ◽

Cited By ~ 7

Author(s):

Pierre Robe ◽

Didier Martin ◽

Jacques Lenelle ◽

Achille Stevenaert

Keyword(s):

Cauda Equina Syndrome ◽

Lumbar Disc ◽

Contrast Material ◽

Cauda Equina ◽

Radicular Pain ◽

Content Type ◽

Diagnostic Pitfalls ◽

Fine Print

✓ The posterior epidural migration of sequestered lumbar disc fragments is an uncommon event. The authors report two such cases in which patients presented with either intense radicular pain or cauda equina syndrome. The radiological characteristics were the posterior epidural location and the ring enhancement of the mass after injection of contrast material. The major diagnostic pitfalls are discussed.

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