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New Study Sheds Light On Cause Of Sciatica

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For years, spinal nerve problems and disc damage were seen as the most common cause of sciatica, a painful condition associated with weakness and tingling in the leg because of pressure on the sciatic nerve.

However, a new study, published in the February issue of the Journal of Neurosurgery: Spine, suggests that piriformis syndrome, a condition in which the piriformis muscle (in the buttocks) irritates the sciatic nerve, may actually be the cause of sciatica pain in some people.

People with spinal problems linked to sciatica are usually recommended to undergo spinal fusion surgery when the real problem might be piriformis syndrome, said study author Dr Aaron Filler from the Cedars-Sinai Institute of Spinal Disorders in Los Angeles.

The study looked at 239 patients whose sciatica symptoms had not improved after diagnosis or treatment for a damaged disc. Seven of the patients had torn disc-related problems (found with usual X-rays and MRI scans) that could be successfully treated with spine surgery. The remaining 232 patients underwent MR neurography, a new method that generates detailed images of the nerves. The researchers found that the majority (69%) had piriformis syndrome, while the other 31% had some other nerve, joint or muscle condition.

Those with piriformis syndrome received an injection of a long-acting anesthetic into the spine, muscle or nerve areas and 85% of them got some relief because of the relaxation of the muscle spasm delivered through the injection. However, relief was short-lived and 62% needed surgery to correct the syndrome, with the majority (82%) showing good or excellent outcomes at the six-year follow-up.

The findings pointing to a new potential culprit for sciatica may help many people suffering from this painful condition. Many undergo lumbar disc surgery but such treatment may fail because disc damage is not the underlying cause, Dr Filler said.

The study provides new clues to sciatica and doctors should consider the possibility that the sciatic pain may be caused by the entrapment of the sciatic nerve by the piriformis muscle. However, further research and evidence is needed before treatment recommendations are made, experts say.