The Experts below are selected from a list of 13917 Experts worldwide ranked by ideXlab platform
Armine Danielyan - One of the best experts on this subject based on the ideXlab platform.
-
Four symptoms define the piriformis syndrome: an updated systematic review of its clinical features
European Journal of Orthopaedic Surgery & Traumatology, 2018Co-Authors: Kevork Hopayian, Armine DanielyanAbstract:Purpose To update the evidence on the clinical features of the piriformis syndrome since the first systematic review published in 2010. Method A systematic review of all case, cross-sectional and prevalence studies. Results The commonest features reported were: buttock pain, pain aggravated on sitting, external tenderness near the greater sciatic notch and pain on any maneuver that increases piriformis muscle tension, and limitation of straight leg raising. The quality of case reports since the previous review has not improved with considerable under-reporting of presumed negative tests. Three recent cross-sectional and prevalence studies have been reported, but the two larger studies are at high risk of bias. Conclusions Piriformis syndrome can be defined by a quartet of symptoms and signs. Many physical tests have been described, but the accuracy of these tests and the symptoms cannot be concluded from studies to date. Straight leg raising does not rule out the diagnosis. Piriformis syndrome is at a stage previously encountered with herniated intervertebral disc: that piriformis muscle pathology can cause Sciatica has been demonstrated, but its prevalence among low back pain and Sciatica sufferers and the diagnostic accuracy of clinical features requires cross-sectional studies free of incorporation and verification biases. One small cross-sectional study provides an encouraging example of how such studies could be conducted but would need replication in a broader population and better reporting.
-
four symptoms define the piriformis syndrome an updated systematic review of its clinical features
European Journal of Orthopaedic Surgery and Traumatology, 2018Co-Authors: Kevork Hopayian, Armine DanielyanAbstract:To update the evidence on the clinical features of the piriformis syndrome since the first systematic review published in 2010. A systematic review of all case, cross-sectional and prevalence studies. The commonest features reported were: buttock pain, pain aggravated on sitting, external tenderness near the greater sciatic notch and pain on any maneuver that increases piriformis muscle tension, and limitation of straight leg raising. The quality of case reports since the previous review has not improved with considerable under-reporting of presumed negative tests. Three recent cross-sectional and prevalence studies have been reported, but the two larger studies are at high risk of bias. Piriformis syndrome can be defined by a quartet of symptoms and signs. Many physical tests have been described, but the accuracy of these tests and the symptoms cannot be concluded from studies to date. Straight leg raising does not rule out the diagnosis. Piriformis syndrome is at a stage previously encountered with herniated intervertebral disc: that piriformis muscle pathology can cause Sciatica has been demonstrated, but its prevalence among low back pain and Sciatica sufferers and the diagnostic accuracy of clinical features requires cross-sectional studies free of incorporation and verification biases. One small cross-sectional study provides an encouraging example of how such studies could be conducted but would need replication in a broader population and better reporting.
Kevork Hopayian - One of the best experts on this subject based on the ideXlab platform.
-
Four symptoms define the piriformis syndrome: an updated systematic review of its clinical features
European Journal of Orthopaedic Surgery & Traumatology, 2018Co-Authors: Kevork Hopayian, Armine DanielyanAbstract:Purpose To update the evidence on the clinical features of the piriformis syndrome since the first systematic review published in 2010. Method A systematic review of all case, cross-sectional and prevalence studies. Results The commonest features reported were: buttock pain, pain aggravated on sitting, external tenderness near the greater sciatic notch and pain on any maneuver that increases piriformis muscle tension, and limitation of straight leg raising. The quality of case reports since the previous review has not improved with considerable under-reporting of presumed negative tests. Three recent cross-sectional and prevalence studies have been reported, but the two larger studies are at high risk of bias. Conclusions Piriformis syndrome can be defined by a quartet of symptoms and signs. Many physical tests have been described, but the accuracy of these tests and the symptoms cannot be concluded from studies to date. Straight leg raising does not rule out the diagnosis. Piriformis syndrome is at a stage previously encountered with herniated intervertebral disc: that piriformis muscle pathology can cause Sciatica has been demonstrated, but its prevalence among low back pain and Sciatica sufferers and the diagnostic accuracy of clinical features requires cross-sectional studies free of incorporation and verification biases. One small cross-sectional study provides an encouraging example of how such studies could be conducted but would need replication in a broader population and better reporting.
-
four symptoms define the piriformis syndrome an updated systematic review of its clinical features
European Journal of Orthopaedic Surgery and Traumatology, 2018Co-Authors: Kevork Hopayian, Armine DanielyanAbstract:To update the evidence on the clinical features of the piriformis syndrome since the first systematic review published in 2010. A systematic review of all case, cross-sectional and prevalence studies. The commonest features reported were: buttock pain, pain aggravated on sitting, external tenderness near the greater sciatic notch and pain on any maneuver that increases piriformis muscle tension, and limitation of straight leg raising. The quality of case reports since the previous review has not improved with considerable under-reporting of presumed negative tests. Three recent cross-sectional and prevalence studies have been reported, but the two larger studies are at high risk of bias. Piriformis syndrome can be defined by a quartet of symptoms and signs. Many physical tests have been described, but the accuracy of these tests and the symptoms cannot be concluded from studies to date. Straight leg raising does not rule out the diagnosis. Piriformis syndrome is at a stage previously encountered with herniated intervertebral disc: that piriformis muscle pathology can cause Sciatica has been demonstrated, but its prevalence among low back pain and Sciatica sufferers and the diagnostic accuracy of clinical features requires cross-sectional studies free of incorporation and verification biases. One small cross-sectional study provides an encouraging example of how such studies could be conducted but would need replication in a broader population and better reporting.
-
The clinical features of the piriformis syndrome: a systematic review
European Spine Journal, 2010Co-Authors: Kevork Hopayian, Fujian Song, Ricardo Riera, Sidha SambandanAbstract:Piriformis syndrome, Sciatica caused by compression of the sciatic nerve by the piriformis muscle, has been described for over 70 years; yet, it remains controversial. The literature consists mainly of case series and narrative reviews. The objectives of the study were: first, to make the best use of existing evidence to estimate the frequencies of clinical features in patients reported to have PS; second, to identify future research questions. A systematic review was conducted of any study type that reported extractable data relevant to diagnosis. The search included all studies up to 1 March 2008 in four databases: AMED, CINAHL, Embase and Medline. Screening, data extraction and analysis were all performed independently by two reviewers. A total of 55 studies were included: 51 individual and 3 aggregated data studies, and 1 combined study. The most common features found were: buttock pain, external tenderness over the greater sciatic notch, aggravation of the pain through sitting and augmentation of the pain with manoeuvres that increase piriformis muscle tension. Future research could start with comparing the frequencies of these features in Sciatica patients with and without disc herniation or spinal stenosis.
Manoel J. B. C. Girão - One of the best experts on this subject based on the ideXlab platform.
-
Vascular entrapment of the sciatic plexus causing catamenial Sciatica and urinary symptoms
International Urogynecology Journal, 2016Co-Authors: Nucelio Lemos, Renato Moretti Marques, Gil Kamergorodsky, Christine Ploger, Eduardo Schor, Manoel J. B. C. GirãoAbstract:Aim of the video / Introduction Pelvic congestion syndrome is a well-known cause of cyclic pelvic pain (Ganeshan et al., Cardiovasc Intervent Radiol 30(6):1105–11, 2007). What is much less well known is that dilated or malformed branches of the internal or external iliac vessels can entrap the nerves of the sacral plexus against the pelvic sidewalls, producing symptoms that are not commonly seen in gynecological practice, such as Sciatica, or refractory urinary and anorectal dysfunction (Possover et al., Fertil Steril 95(2):756–8. 2011). The objective of this video is to explain and describe the symptoms suggestive of vascular entrapment of the sacral plexus, as well as the technique for the laparoscopic decompression of these nerves. Method Two anecdotal cases of intrapelvic vascular entrapment are used to review the anatomy of the lumbosacral plexus and demonstrate the laparoscopic surgical technique for decompression at two different sites, one on the sciatic nerve and one on the sacral nerve roots. Result After surgery, the patient with the sciatic entrapment showed full recovery of the Sciatica and partial recovery of the myofascial pain. The patient with sacral nerve root entrapment showed full recovery with resolution of symptoms. Conclusion The symptoms suggestive of intrapelvic nerve entrapment are: perineal pain or pain irradiating to the lower limbs in the absence of a spinal disorder, and lower urinary tract symptoms in the absence of prolapse of a bladder lesion. In the presence of such symptoms, the radiologist should provide specific MRI sequences of the intrapelvic portion of the sacral plexus and a team and equipment to expose and decompress the sacral nerves should be prepared.
Ulrich Batzdorf - One of the best experts on this subject based on the ideXlab platform.
-
Sciatica of nondisc origin and piriformis syndrome diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment
Journal of Neurosurgery, 2005Co-Authors: Aaron G Filler, Jodean Haynes, Sheldon E Jordan, Joshua Prager, Pablo J Villablanca, Keyvan Farahani, Duncan Q Mcbride, Jay S Tsuruda, Brannon Morisoli, Ulrich BatzdorfAbstract:Object. Because lumbar magnetic resonance (MR) imaging fails to identify a treatable cause of chronic Sciatica in nearly 1 million patients annually, the authors conducted MR neurography and interventional MR imaging in 239 consecutive patients with Sciatica in whom standard diagnosis and treatment failed to effect improvement. Methods. After performing MR neurography and interventional MR imaging, the final rediagnoses included the following: piriformis syndrome (67.8%), distal foraminal nerve root entrapment (6%), ischial tunnel syndrome (4.7%), discogenic pain with referred leg pain (3.4%), pudendal nerve entrapment with referred pain (3%), distal sciatic entrapment (2.1%), sciatic tumor (1.7%), lumbosacral plexus entrapment (1.3%), unappreciated lateral disc herniation (1.3%), nerve root injury due to spinal surgery (1.3%), inadequate spinal nerve root decompression (0.8%), lumbar stenosis (0.8%), sacroiliac joint inflammation (0.8%), lumbosacral plexus tumor (0.4%), sacral fracture (0.4%), and no diagnosis (4.2%). Open MR‐guided Marcaine injection into the piriformis muscle produced the following results: no response (15.7%), relief of greater than 8 months (14.9%), relief lasting 2 to 4 months with continuing relief after second injection (7.5%), relief for 2 to 4 months with subsequent recurrence (36.6%), and relief for 1 to 14 days with full recurrence (25.4%). Piriformis surgery (62 operations; 3-cm incision, transgluteal approach, 55% outpatient; 40% with local or epidural anesthesia) resulted in excellent outcome in 58.5%, good outcome in 22.6%, limited benefit in 13.2%, no benefit in 3.8%, and worsened symptoms in 1.9%. Conclusions. This Class A quality evaluation of MR neurography’s diagnostic efficacy revealed that piriformis muscle asymmetry and sciatic nerve hyperintensity at the sciatic notch exhibited a 93% specificity and 64% sensitivity in distinguishing patients with piriformis syndrome from those without who had similar symptoms (p , 0.01). Evaluation of the nerve beyond the proximal foramen provided eight additional diagnostic categories affecting 96% of these patients. More than 80% of the population good or excellent functional outcome was achieved.
Jaakko Niinimaki - One of the best experts on this subject based on the ideXlab platform.
-
the treatment of disc herniation induced Sciatica with infliximab one year follow up results of first ii a randomized controlled trial
Spine, 2006Co-Authors: Timo Korhonen, Jaro Karppinen, Leena Paimela, Antti Malmivaara, Karlaugust Lindgren, Chris Bowman, Anthony Hammond, Bruce Kirkham, Simo Jarvinen, Jaakko NiinimakiAbstract:Study Design. A randomized controlled trial. Objectives. To evaluate the long-term efficacy of infliximab, a monoclonal antibody against tumor necrosis factor alpha (TNF-alpha), in patients with acute/subacute Sciatica secondary to herniated disc. Summary of Background Data. The results of experimental studies and our open-label trial support the use of infliximab in Sciatica. Here we report the 1-year results of a randomized controlled trial (FIRST II, Finnish Infliximab Related STudy) evaluating the efficacy and safety of a single infusion of infliximab for sciatic pain. Methods. Inclusion criteria were unilateral sciatic pain with a disc herniation concordant with the symptoms and signs of radicular pain. Patients had to be candidates for discectomy. Criteria for discectomy included (in addition to a symptomatic disc herniation on MRI) neural entrapment (straight leg raising [SLR] Results. Sixty-seven percent of patients in the infliximab group reported no pain at 52 weeks compared with 63% in the control group (P = 0.72). Similar efficacy was observed between treatment groups for other outcomes. Eight patients in each group required surgery. Three non-serious adverse reactions were encountered in the infliximab group. The response ( irrespective of the treatment) was significantly better with shorter symptom duration and less SLR restriction at baseline. Patients in the infliximab group appeared to especially benefit in cases of a L4-L5 (or L3-L4) herniation and if a Modic change was colocalized at the symptomatic level. Conclusions. Although the long-term results of this randomized trial do not support the use of infliximab compared with placebo for lumbar radicular pain in patients with disc herniation-induced Sciatica, further study in a subgroup of patients with L4-L5 or L3-L4 herniations, especially in the presence of Modic changes, appears to be warranted.
-
the treatment of disc herniation induced Sciatica with infliximab results of a randomized controlled 3 month follow up study
Spine, 2005Co-Authors: Timo Korhonen, Jaro Karppinen, Leena Paimela, Antti Malmivaara, Karlaugust Lindgren, Simo Jarvinen, Jaakko Niinimaki, Nic Veeger, Seppo Seitsalo, Heikki HurriAbstract:Study Design. A randomized controlled trial. Objectives. To evaluate the efficacy of infliximab, a monoclonal antibody against tumor necrosis factor (TNF)-alpha in a randomized controlled setting. Summary of Background Data. Recently, we obtained encouraging results in an open-label study of infliximab in patients with disc herniation-induced Sciatica. Furthermore, the results of experimental studies support the use of infliximab in Sciatica. Therefore, we initiated a randomized, controlled trial (FIRST II, Finnish Infliximab Related STudy) to confirm the efficacy of a single infusion of infliximab for sciatic pain. Methods. Inclusion criteria were unilateral moderate to severe sciatic pain with an MRI-confirmed disc herniation concordant with the symptoms and signs of radicular pain. Patients had to be candidates for discectomy, as evaluated by an independent orthopedic surgeon. Forty patients were allocated to a single intravenous infusion of either infliximab 5 mg/kg or placebo. Assessments at baseline and various time points included clinical examination with measurement of straight leg raising restriction; questionnaires related to subjective symptoms ( leg and back pain by 100-mm visual analog scale, Oswestry disability); sick leaves; number of discectomies; and adverse effects possibly related to treatment. The primary endpoint was a reduction in leg pain from baseline to 12 weeks, which was analyzed using a Mann-Whitney U test and repeated-measures analysis. Results. A significant reduction in leg pain was observed in both groups, with no significant difference between treatment regimens. Similar efficacy was observed between treatment groups for secondary endpoints. Seven patients in each group required surgery. No adverse effects related to treatment were encountered. Conclusions. The results of this randomized trial do not support the use of infliximab for lumbar radicular pain in patients with disc herniation-induced Sciatica.
-
tumor necrosis factor alpha monoclonal antibody infliximab used to manage severe Sciatica
Spine, 2003Co-Authors: Jaro Karppinen, Timo Korhonen, Leena Paimela, Antti Malmivaara, Karlaugust Lindgren, Jaakko Niinimaki, Eero Kyllonen, Pekka Rantanen, Osmo Tervonen, Seppo SeitsaloAbstract:Study design An open-label study was conducted. Objective To evaluate the efficacy and safety of infliximab, a monoclonal chimeric antibody, against tumor necrosis factor-alpha (TNFalpha) for the treatment of severe Sciatica. Summary of background data Evidence from animal studies indicates that TNFalpha plays a role in the pathophysiology of Sciatica. Anti-TNFalpha therapy has not been previously evaluated in sciatic patients. Methods In this study, 10 patients with disc herniation-induced severe Sciatica received infliximab (Remicade 3 mg/kg) intravenously over 2 hours. The outcome was assessed at 1 hour, 1 week, 2 weeks, 1 month, and 3 months after the infusion and compared to historical control subjects consisting of 62 patients who received saline in a trial of periradicular infiltration for Sciatica. Leg pain was the primary outcome, with more than a 75% decrease from the baseline score constituting a painless state. Fisher's exact test and repeated measures analysis of variance were used for statistical analysis. Results At 1 hour after the infusion, leg pain had decreased by 50%. At 2 weeks, 60% of the patients in the infliximab group were painless, as compared with 16% of the control patients (P = 0.006). The difference was sustained at 3 months (90% vs 46%; P = 0.014). Infliximab was superior over the whole follow-up period in terms of leg pain (P = 0.003) and back-related disability (P = 0.004). At 1 month, every patient in the infliximab group had returned to work, whereas 38% of the control subjects still were on sick leave (P = 0.02). None of the patients treated with infliximab underwent surgery during the follow-up period. No immediate or delayed adverse drug reactions and no adverse effects related to medication were observed. Conclusions Anti-TNFalpha therapy is a promising treatment option for Sciatica. There is an urgent need for a randomized controlled trial to evaluate whether thesepromising early results can be confirmed.