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year-old woman with buttock pain thought to result from S1 periradicular cyst detected on previous MRI. Coronal STIR sequence of lumbosacral plexus and pelvis shows areas of increased signal intensity related to subchondral osteitis of both sacroiliac joints (arrowheads).
Source publication
Objective:
In some cases, sciatica-like symptoms radiating through the buttock, anterior thigh, or leg result from spinal root compression in an extraspinal location or from injury to the pelvic girdle. It has been suggested that adding a coronal STIR sequence dedicated to the lumbosacral plexus and pelvis to the routine MRI protocol can provide a...
Context in source publication
Context 1
... cases of unexpected sacroiliitis were revealed by the coronal STIR sequence (Fig. 1). It is known that sacroiliitis may in some cases result in sciatica-like symptoms radiat- ing to the lower limbs. This condition, some- times reported as nondiscogenic sciatica, may result from two different mechanisms: first, the sacroiliac joint may generate referred pain to the lower limbs because they share the same somatic ...
Similar publications
Deep gluteal syndrome (DGS) is a term applied to a medical condition consisting of pain and paresthesias radiating from the buttock area along the sciatic nerve territory and not related to a discogenic etiology. The spectrum of pathologies related to non-discogenic sciatica is wide. Thus, this syndrome is a complex clinical entity that was difficu...
Citations
... To our knowledge, only one study has investigated the value of the coronal STIR sequence in a review of low back pain with radiculopathy: Laporte et al. suggested that this sequence should be performed essentially when no obvious radicular conflict had been demonstrated on the usual sequences centered on the lumbar spine and lumbosacral hinge [15]. As a continuation of this study, it seems interesting to us to evaluate the systematic use of this MRI sequence on a larger number of unselected patients (sciatica or cruralgia) to clarify its diagnostic relevance. ...
... The value of additional MRI sequences, such as coronal STIR in the investigation of lumbar radiculopathy, has been scarcely reported in the literature so far (15). This study illustrates that there may be overlap in the lumbar radiculopathy between discoradicular impingement and other causes of radiating pain in an extraspinal location, including troncular nerve entrapment or differential diagnoses in a large cohort of 600 patients consecutively included. ...
... The study by Laporte et al. [15], whose inclusion criteria were similar to ours, reported 5.7% (12/209) of clinically related ESA. Unlike Laporte et al., we made the choice to include ESA that seemed significant, even if there was already a spinal cause that could explain the symptoms of the radiculopathy. ...
Objective:
Lumbar radiculopathy mainly originates in the spine (lumbar disc herniation or spine osteoarthritis) but can sometimes be explained by extra-spinal nerve compression or confused with referred pain mimicking radiculopathy. Our main objective was to demonstrate the clinical benefit of the large-field coronal STIR (coroSTIR) sequence in the etiological assessment of lumbar radiculopathy with a duration of more than six weeks.
Materials and methods:
Six hundred consecutive lumbar MRI scans performed using the same protocol were retrospectively reviewed. Two musculoskeletal radiologists independently assessed the coroSTIR sequence for the presence of extra-spinal anomalies (ESA) that could explain or contribute to the lumbar radiculopathy. The presence of an ESA was then correlated with sex, age, topography and lateralization of radiculopathy, history of vertebral surgery, as well as the presence of a spinal cause explaining the symptoms. Extra-spinal incidentalomas (ESI) with potential clinical impact visible only on the coroSTIR sequence were also systematically reported.
Results:
An extra-spinal cause was detected on the coroSTIR sequence in 68 cases (11.3%), mainly gluteal tendinobursitis (30.9%), congestive hip osteoarthritis (25%), degenerative sacroiliac arthropathy (14.7%), or inflammatory sacroilitis (7.3%). Their prevalence was significantly correlated in multivariate regression with age (58 years vs. 53 years, p = 0.01), but not with the type of radiating pain (sciatica or cruralgia). The presence of ESI was also frequent (70 cases, 11.7%), including some potentially severe diagnoses (38% of tumor or pseudo-tumor mass requiring further assessment or monitoring).
Conclusions:
Considering its acceptable acquisition time, the detection of a significant number of potentially symptom-related extra-spinal anomalies, and the discovery of a non-negligible number of extra-spinal incidentalomas with potential clinical impact, the coronal STIR should be performed systematically in routine MRI for lumbar radiculopathy.
... MRN with the dedicated protocol for LSP showed significant correlation between abnormal intraneural T2 signal and active radiculopathy verified on EMG, although the positive MRN was not associated with subjective clinical symptom (44). Moreover, abbreviated MRN such as a single coronal STIR sequence added to routine spine MRI protocol discovered abnormalities which may have not been found with the spine MRI (45). In another study, MRN (48,49). ...
Purpose MR neurography (MRN) is an imaging technique optimized to visualize the peripheral
nerves. This review
aimed to discover an optimized protocol for MRN of the lumbosacral plexus (LSP)
and identify evidence for the clinical benefit of lumbosacral plexopathies.
Materials and Methods We performed a systematic search of the two medical databases until September
2021. ‘Magnetic resonance imaging’, ‘lumbosacral plexus’,
‘neurologic disease’, or equivalent
terms were used to search the literature. We extracted information
on indications, MRN protocols for
LSP, and clinical efficacy from 55 studies among those searched.
Results MRN of the LSP is useful for displaying the distribution of peripheral nerve disease, guiding
perineural injections, and assessing extraspinal causes of sciatica. Three-dimensional short-tau inversion
recovery turbo spin-echo combined with vascular suppression is the mainstay of MRN.
Conclusion Future work on the MRN of LSP should be directed to technical maturation and clinical
validation
of efficacy.
... Variable etiologies can be behind extraspinal sciatica: traumatic, infective, neoplastic, vascular, and gynecological, all of which might be easily overlooked on routine MRI protocol. Although MRI is the modality of choice for investigating sciatica, its routine protocol, constituted by sagittal views of the lumbar spine and axial views along the disc planes, does not allow detection of extraspinal causes of sciatica or sciatica-like symptoms [3,4]. ...
... With STIR sequences, all tissues of short T1 relaxation times, including fat, are suppressed, whereas tissue with high water content, including most pathologic lesions, are accentuated, yielding a bright signal on a dark background of nullified short-T1 tissue [5]. Adding a STIR sequence in coronal view to cover the bony pelvic girdle and surrounding soft tissues, including the lumbosacral plexus and branches, is thought to be useful in detection of extraspinal etiologies of sciatica and sciatica-like symptoms that may be missed on routine imaging protocol [4,6,7]. ...
... Sciatica is the most common neurological spine disease [8]. It is defined by low back pain that radiates to the legs, with or without neurologic deficiency [4]. Although most patients with lumbar disc herniation present with sciatica, patients may also present with less common sciatica-like symptoms such as MRI is usually the modality of choice when investigating sciatica. ...
... Disorders affecting the lumbosacral plexus are often misdiagnosed as they are uncommon and their symptoms mimic those of lumbosacral radiculopathy [8]. One study found that disorders affecting the lumbosacral plexus and/or gluteal region contributed to symptoms in 6% of cases of sciatic pain; however, these conditions were not visualized by a standard lumbar MRI series [9]. Clinical features suggestive of a lumbosacral plexus disorder include signs and This article is part of the Topical Collection on Medicine symptoms spanning multiple nerve root levels, absence of significant low back pain, and absence of pain with coughing/straining [8]. ...
... Clinical features suggestive of a lumbosacral plexus disorder include signs and This article is part of the Topical Collection on Medicine symptoms spanning multiple nerve root levels, absence of significant low back pain, and absence of pain with coughing/straining [8]. Special imaging techniques such as magnetic resonance neurography or coronal short tau inversion recovery (STIR) [9] or electrodiagnostic evaluations [8] can be helpful in their diagnosis. ...
Sciatic endometriosis is a rare condition in which endometrial tissue invades or compresses the lumbosacral plexus and/or sciatic nerve and causes sciatic pain, which is often cyclical. Its diagnosis depends on the recognition of signs and symptoms atypical to common degenerative lumbar disorders and its treatment requires timely and coordinated care. A 26-year-old woman presented to a chiropractor at a hospital-based outpatient clinic with a 6-month exacerbation of radiating pain and paresthesia from the right gluteal region into the leg and foot. She was previously treated for over 3 months for suspected lumbosacral radiculopathy with physical therapy. Multisegmental neurologic deficits inconsistent with her prior lumbar imaging prompted further investigation. Pelvis and hip MRI identified a 7×5 cm mass extending through the greater sciatic foramen which compressed and infiltrated the lumbosacral plexus, sciatic nerve, and superior gluteal nerve, and was confirmed via biopsy to be endometriosis. Referral and co-management with a neurologist and obstetrician resulted in a conservative strategy of hormone therapy with the option of having surgical excision if needed. Sciatic endometriosis is a rare disorder that may be misdiagnosed due to its tendency to mimic common lumbar disorders. This case highlights the role of a chiropractor coordinating care for a complex disorder that benefits from early diagnosis for optimal management. It also illustrates how integration of chiropractors into a hospital system can facilitate their ability to manage neuro-musculoskeletal disorders as they can easily refer to and communicate with other medical specialties within the network.
... The protocol consisted of sagittal T1W [slice thickness, 4 mm; field of view (FOV), 280 mm; matrix, 307×384; repetition time (TR)/echo time (TE), 400/8; and scan duration, 2.24 min], sagittal T2W (slice thickness, 4 mm; FOV, 280 mm; matrix, 280×384; TR/TE, 3000/120; and scan duration, 1.6 min), and axial T2W (slice thickness, 4 mm; FOV, 230 mm; matrix, 256×256; TR/TE, 3000/120; and scan duration 3 min). Axial images were performed at selected levels chosen from the sagittal sequences, angled through the intervertebral discs [5]. ...
Objective
This study aimed to evaluate the causes of low back pain (LBP) by MRI among the adults.
Patients and methods
This was a prospective study carried out at Al-Zahraa University Hospital. Adequate clinical history was taken from patients complaining of LBP, and MRI was performed for these patients, from March 2020 to August 2020. The patients were categorized according to age, sex, characterization of pain, and finding of MRI.
Results
This study was performed on 100 patients ranging in age from 20 to 70 years and revealed that the majority of patients were obese females, representing 52 (52%) patients, and belonged to the age group of more than 45 years [61 (61%) patients]. In most cases, the pain is associated with sciatica [70 (70%) patients], and the most common cause of LBP was spondylodegenerative changes [80 (80%) patients].
Conclusion
LBP is a common health problem in our locality, and MRI is a good diagnostic tool for evaluation of causes of LBP.
... So, searching new strategies with new compounds became essential in the effective treatment of neuropathic pain [31]. Peripheral neuropathy is characterized by nerve damage and its compressive nature is explained in radiculopathy or sciatica which involves lower extremities and is related to disc herination [32]. Neuropathic pain is associated with oxidative stress and is induced by imbalance of the cellular redox system based on ROS excessive production or dysfunction of the endogenous antioxidant system. ...
Background
Chronic neuropathic pain syndrome is associated with impaired quality of life and is poorly manageable. Alpha lipoic acid (ALA) is a powerful antioxidant and showed its effectiveness on diabetic neuropathy and other acute peripheral nerve injuries but it was not evaluated in the chronic neuropathic pain, chronic constriction injury (CCI) in rat model by using duloxetine (DLX) as standard.
Methodology
The main objective of the study was to expedite ALA effect on chronic peripheral neuropathy induced by CCI of sciatic nerve in rats. In this study, male Wister rats were randomly divided into six groups (n = 8) including, normal saline, sham operated, surgery control, DLX 30mg/kg treated, ALA treated 25mg/kg, and ALA+DLX. The CCI of sciatic nerve was conducted on all animals except normal saline group and studied for 21 days (i.e. 14 days treatment period & 7 days treatment free period) by using different behavioral, biochemical and, histopathology studies.
Results
ALA showed minor but significant decrease of thermal hyperalgesia, cold allodynia, malondialdehyde (MDA), total protein, lipid peroxidation, and nitric oxide levels and significant increase of motor coordination, glutathione level and decreased axonal degeneration significantly. These effects sustained even during treatment free period. ALA enhanced the effect of DLX when given in combination by showing sustained effect. In conclusion, ALA acted as potent antioxidant may be this activity is responsible for the potent neuroprotective effect.
Conclusion
Hence, ALA attenuated the nueroinflammation mediated by chronic peripheral neuropathy. Further studies are warranted with ALA to develop as a clinically relevant therapeutic agent for the treatment of neuropathic pain.
... La RM de plexo lumbosacro que se llevó a cabo en la Paciente 6 para evaluar la anatomía del nervio, mostró un engrosamiento fusiforme del nervio ciático y de la raíz L4 y L5, con aumento de señal en T2 y una arquitectura fascicular interna preservada, similar a lo descrito en la literatura en casos de perineurioma intraneural 25 . El uso de neurografía por RM ha sido reconocido como un método eficaz para evaluar la anatomía de raíces y grandes nervios, en neuropatías tumorales y plexopatías inflamatorias, así como de estructuras adyacentes que pudiesen causar compresión o infiltración 26,27 . En suma, la RM permite visualizar tanto la estructura del nervio y estructuras vecinas, como de los músculos comprometidos en forma secundaria. ...
Introduction:
Sciatic neuropathy is rare and difficult to diagnose in pediatrics, and its long-term course has not been completely understood.
Objective:
To analyze the clinical presentation and evolution of a group of pediatric patients with sciatic neuropathy.
Patients and Method:
Retrospective anal ysis of the clinical characteristics of pediatric patients with sciatic neuropathy treated in two hospitals of Santiago between 2014 and 2018. Locomotor examination, muscle trophism, deep tendon reflexes, gait, sensation, and pain were assessed. Sciatic nerve conduction study and electromyography (EMG) were performed, and magnetic resonance imaging (MRI) in three patients.
Results:
Six patients were included with an average age of 11.8 years. The etiologies were traumatic (N = 2), by compression (N = 2), vascular (N = 1), and tumor (N = 1). All of the 6 patients presented foot drop and Achilles tendon hyporeflexia/areflexia, and 5 patients presented severe neuropathic pain. The EMG showed involvement of the sciatic nerve rami and dependent muscles. In two patients, a pelvic girdle and lower limbs MRI was performed, showing selective muscle involvement in sciatic territory. One patient underwent a lumbosacral plexus MRI, and subsequently histological study showing a benign neural tumor. Out of the three patients who were followed-up longer than one year presented motor sequelae and gait disorder.
Conclusion:
Sciatic neuropathy in the study group was secondary to different causes, predominantly traumatic and compressive etiologies. The three patients that were ina long-term follow-up presented significant motor sequelae. In most of the cases, neural injury wasassoci- ated with preventable causes, such as accidents and positioning in unconscious children, which is crucial in the prevention of a pathology with a high sequelae degree.
... All of which might be easily overlooked on routine magnetic resonance imaging (MRI) protocol. Although MRI is the modality of choice for investigating sciatica, however its routine protocol, constituted by sagittal views of the lumbar spine and axial views along the disc planes, does not allow detection of extra spinal causes of sciatica or sciatica-like symptoms [3,4]. ...
... With STIR sequences, all tissues of short T1 relaxation times, including fat, are suppressed, whereas tissue with high water content, including most pathologic lesions, are accentuated, yielding a bright signal on a dark background of nullified short-T1 tissue [5]. Adding a STIR sequence in coronal view to cover the bony pelvic girdle and surrounding soft tissues, including the lumbosacral plexus and branches, is thought to be useful in detection of extra-spinal etiologies of sciatica and sciatica-like symptoms that may be missed on routine imaging protocol [4,6,7]. ...
... This can be explained that coronal images field of view in their study was limited to the sacrum and sacroiliac joints; while in our study, the FOV was extended down to the lesser trochanters of the femora allowing the detection of abnormalities within the pelvis and hips. In other studies, reported a percentage close to that in our study, 6.8% by Gupta and his colleagues and 5.7% by Laporte and his colleagues [4,6]. ...
Background
The value of adding coronal STIR images to MR imaging of sciatica aiming to detect extra-spinal abnormalities.
Results
Additional coronal STIR images detected extra-spinal abnormalities in 20% of the patients, thereby downgraded the normal studies from 21 to 13%. The extra-spinal abnormalities included bone abnormalities (36.4%), soft tissue abnormalities (4.5%), neurological abnormalities (2.3%), gynecological abnormalities (50%), and miscellaneous (6.8%). In 6.9% of patients, the extra-spinal abnormalities explained the patients’ pain and influenced their management. Extra-spinal causes of pain significantly correlated to positive trauma and neoplasm history, normal routine protocol images, and absent nerve root impingement. Extra-spinal abnormalities were more prevalent in age groups (20–39 years).
Conclusion
Coronal STIR images (field of view: mid abdomen to the lesser trochanters) identify extra-spinal abnormalities that maybe overlooked on routine MRI protocol. It is of additional value in young adults, trauma, neoplasm, and negative routine images.
... One study that performed both lumbar and pelvic MRI on 209 patients with sciatica found that symptoms were due to sacroiliitis (inflammation of the SIJ) in only 1% of the patients. 14 In the early 1900s, prior to the popularization of LDH as a diagnosis, clinicians believed the SIJ was a major cause of sciatica. The first medical doctor to give attention to the SIJ as a cause of sciatica was the British surgeon John Hilton in 1879. ...
• Low back disorders are the most common cause of sciatica
• Gluteal region disorders are the second most common cause of sciatica
• Systemic illness such as autoimmune or vascular disease may contribute to sciatica
• Patients may have more than one source of pain
... 7,28 Additional imaging of the pelvis or lumbosacral plexus may identify the cause of sciatica when lumbar imaging fails to do so, or does not correlate with the patient's symptoms. 7,28,29 Exiting vs. traversing root Discogenic sciatica most often affects at least one traversing nerve root passing inferior to the disc lesion, and less often one or more exiting nerve roots at the level of herniation, iv in a ratio of nearly 2:1. [19][20][21][22][23] Disc herniations can also migrate superiorly or inferiorly and affect proximal and distal roots. ...
• Imaging is necessary given certain signs or symptoms or a lack of response to treatment
• Imaging findings should correlate with the patient’s symptoms; lack of correlation should prompt further investigation for the source of pain
• Laboratory testing may help diagnose the source of sciatica and find barriers to recovery
