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Title: NON DISCOGENIC SCIATICA MIMICKING DISORDERS : A DILEMMA FOR NEUROSURGEONS IN MAKING SURGICAL DECISIONS: A REPORT OF 81 PATIENTS FROM ALI INSTITUTE OF NEUROSCIENCES, IRFAN GENERAL HOSPITAL
Authors: Mumtaz Ali, Akram Ullah, Ramzan Hussain, Arif Hussain, Sajid Khan, Hanif Ur Rahman, Amjad Ali
Journal: Rehman Journal of Health Sciences
Publisher: Affiliated with Khyber Medical University
Country: Pakistan
Year: 2023
Volume: 5
Issue: 1
Language: English
ABSTRACT
Introduction: The cause of sciatica is not always discogenic and majority of patients are misdiagnosed as having discogenic sciatica while the underlying non discogenic causes are overlooked. This study aimed at evaluating the frequency of non-discogenic sciatica in patients presenting with lumber radiculopathy.
Material & Methods: A prospective case series study was conducted from February 2022 to January 2023 at Ali Institute of Neurosciences, Irfan General Hospital Peshawar. Nonprobability convenience sampling technique was incorporated. A total of 624 patients were reported to the OPD with clinical presentations of sciatica out of which 81 patients were included after thorough subjective, objective, and radiological investigation. Data was analysed using SPSS version 26.
Results: Five hundred forty-three (87%) patients were diagnosed with discogenic sciatica while 81(13%) patients were categorized under non discogenic disorders causing radicular symptoms. Majority of the patients 51(63%) were males as compared to females 30(37%) in the non-discogenic group. Out of 81 cases diagnosed with non-discogenic sciatica,26 cases (32%) were due to spinal tumours, facet dysfunction 10(12%), piriformis syndrome6(7%), cluneal nerve disorder2(2%), quadratus lumborum dysfunction4(5%), osteoarthritis of the hip3(4%), peripheral nerve disorders 8(10%), sacroiliac joint 3(4%) infections 10(13%),trauma to gluteal region 3(4%), pregnancy associated sciatica 2(2%), compressive neuropathy 4(5%).
Conclusion: There are a number of non-discogenic disorders causing symptoms of lumber radiculopathy. Identifying the underlying non discogenic cause is still challenging. Considering the possible pathologies, detailed history taking and objective examination along with diagnostic tests and investigations can lead to the identification of underlying pathologies and their management.
Key Words: lumber radiculopathy, non-discogenic, sciatica
To evaluate the frequency of non-discogenic sciatica in patients presenting with lumber radiculopathy.
Prospective case series study conducted from February 2022 to January 2023 at Ali Institute of Neurosciences, Irfan General Hospital Peshawar. Nonprobability convenience sampling was used. 624 patients were reported, with 81 patients included after subjective, objective, and radiological investigation. Data was analyzed using SPSS version 26.
graph TD
A[Patients Reported with Sciatica] --> B[Exclude Disc Pathology];
B -- Yes --> C[Discogenic Sciatica Diagnosis];
B -- No --> D[Subjective Examination];
D --> E[Objective Examination];
E --> F[Radiological & Lab Investigations];
F --> G[Non-Discogenic Sciatica Diagnosis];
G --> H[Data Analysis];
H --> I[Conclusion];
Long-lasting lumber radiculopathy symptoms unresponsive to typical treatments suggest non-discogenic causes. The study's findings align with previous research indicating that non-discogenic disorders, while less common, can mimic sciatica symptoms. A case was highlighted where a patient had both disc herniation and a tumor compressing neural structures.
87% of patients were diagnosed with discogenic sciatica, while 13% were categorized under non-discogenic disorders. Among non-discogenic cases, 32% were due to spinal tumors, 12% facet dysfunction, 7% piriformis syndrome, 2% cluneal nerve disorder, 5% quadratus lumborum dysfunction, 4% osteoarthritis of the hip, 10% peripheral nerve disorders, 4% sacroiliac joint issues, 13% infections, 4% trauma to gluteal region, 2% pregnancy-associated sciatica, and 5% compressive neuropathy.
Non-discogenic pathologies such as spinal tumors, facet dysfunction, infections, piriformis syndrome, compressive neuropathy, sacroiliac joint dysfunction, and cluneal nerve disorder can cause sciatica. Detailed history, objective examination, diagnostic tests, and investigations are crucial for identifying underlying pathologies.
1. The study was conducted from February 2022 to January 2023. Confirmed by the Material & Methods section.
2. 87% of patients were diagnosed with discogenic sciatica. Confirmed by the Results section.
3. 32% of non-discogenic sciatica cases were due to spinal tumors. Confirmed by the Results section.
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