Electromyographic Abnormalities Associated with Symptomatic Sacral Tarlov Cysts

Tarlov or perineural cysts (TC) are commonly overlooked as a cause of sacral and ischial pain, and urogenital and bowel problems. TC can be seen on MRI, but are often considered asymptomatic. This is especially true for smaller cysts. Moreover, there are only few diagnostic characteristics that can be used to confirm that the cysts are the cause of the symptoms. As a consequence, a lot of controversy remains regarding the clinical importance of TC. Because of this underdiagnosed condition, patients often suffer for several years from unrecognized chronic neuropathic pain and neurological conditions. In this article, case reports of three patients with giant and smaller symptomatic sacral cysts are presented, in which electromyographic testing was performed to demonstrate nerve damage. We suggest that electromyography of the sacral nerve roots can be a reasonable tool for the diagnosis of symptomatic TC, as well as for the differentiation from other pathological entities causing sacral and ischial pain. Moreover, using electromyography it was also documented that smaller cysts of < 1 cm can cause nerve damage. Therefore incidence of symptomatic TC may be higher than initially thought.     

针刺治疗坐骨神经痛的文献质量评价

目的:对针刺治疗坐骨神经痛的临床文献进行质量评价。方法:通过电子检索万方数据库获得所有涉及针刺治疗坐骨神经痛的临床文献,选择符合纳入标准的文献,评价其方法。结果:在纳入的187篇文献中,其中随机对照文献仅占24.60%,对46篇随机对照文献进行分析:仅有10.87%的文献对随机分组的方法进行了描述,67.39%的文献对组间均衡性进行了描述,56.52%的文献明确诊断标准。结论:针刺治疗坐骨神经痛的文献质量还需要提高。     

滞针术配合电针治疗根性坐骨神经痛疗效观察

目的观察滞针术配合电针治疗根性坐骨神经痛的临床疗效。方法将131例患者随机分为滞针组(68例)和电针组(63例),两组均取腰3-5夹脊穴、环跳、秩边、委中等穴予电针疗法,滞针组同时选阿是穴施用滞针术。两组均治疗14次,观察临床疗效及疼痛视觉模拟评分(VAS)变化情况。结果滞针组、电针组总有效率分别为100.0%、88.9%,治疗组临床疗效优于对照组(P0.05);治疗后两组VAS积分均较治疗前减少(P0.05),且滞针组减少幅度大于电针组(P0.05)。结论滞针术配合电针治疗根性坐骨神经痛疗效良好。     

补肝益肾通络汤治疗坐骨神经痛临床研究

目的:观察补肝益肾通络汤治疗坐骨神经痛的临床疗效。方法:88例坐骨神经痛患者随机分为观察组和对照组各44例。对照组给予西医常规治疗,观察组在对照组基础上给予独活寄生汤治疗。观察两组患者坐骨神经痛发作频率、持续时间及疼痛程度。结果:治疗后观察组发作频率、持续时间以及疼痛程度均显著优于对照组(P0.05)。结论:补肝益肾通络汤治疗治疗坐骨神经痛疗效显著。     

Low back pain investigations and prognosis: a review

Low back pain is reviewed in terms of when investigations are useful and its clinical course. Despite the extensive evaluation of the accuracy of investigations such as radiography, magnetic resonance imaging, and myelography, there is a surprising dearth of research to inform their use in primary care. There is no clear evidence on which to base judgments for selection of appropriate tests to confirm or exclude low back pain pathology. It appears that investigations are rarely necessary for low back pain. Specific investigations should be ordered to identify a particular pathology but should not be ordered routinely for general screening. In the absence of pathology, low back pain and its associated disability improve rapidly in the first weeks after onset, but, in contradiction to all guidelines, both commonly persist and the best evidence suggests that recurrences are common.     

X线引导经椎间孔硬膜外注射治疗坐骨神经痛

目的探讨X线引导经椎间孔硬膜外注射类固醇治疗腰椎间盘突出所致坐骨神经痛的临床价值。方法2004年10月-2007年12月,应用经椎间孔硬膜外类固醇注射术（TFESI）治疗坐骨神经痛患者79例,病程8周～22年,平均3．6个月。采用11点疼痛评分（VSA）和5点患者满意度评分,分别于术前,术后6个月、12个月进行疼痛评估。结果穿刺点距棘突正中线3．8～8．0cm,穿刺成功率100％。TFESI术前,79例VAS评分3．5～9．5分,平均6．5分。6个月随访,VAS评分0～9．5分,平均3．8分;其中疗效优45．5％,良35．4％,无效18．9％,有效率80．9％。12个月随访,VAS评分0～9．5分,平均4．1分;其中优45．5％,良32．9％,无效21.4％,有效率78．4％。术中血管内穿刺7例,术后15min内,发生头痛2例,血压升高、血压降低各l例;术后24h内腰腿痛加剧4例;术后1周发生皮疹1例,月经紊乱1例;以上并发症均经对症治疗或停药处理后好转。未发生穿破硬脊膜、硬膜下注射、感染等严重并发症。 结论TFESI是一种安全、有效的坐骨神经痛替代治疗方法。     

Sciatic neuralgia associated with a perineural (Tarlov) cyst

Perineural (Tarlov) cysts are rare and are usually asymptomatic and an incidental finding on routine spinal imaging. Presented here is a case of sciatic neuralgia in a 56-year-old patient whose clinical symptoms correlated with a lower lumbar perineural cyst.     

Perisciatic Ultrasound‐Guided Infiltration for Treatment of Deep Gluteal Syndrome

The objective of this study was to describe a perisciatic ultrasound‐guided infiltration technique for treatment of deep gluteal syndrome and to report its preliminary clinical results. A mixture of saline (20 mL), a local anesthetic (4 mL), and a corticosteroid solution (1 mL) was infiltrated in the perisciatic region between the gluteus maximus and pelvitrochanteric muscles. Relative pain relief was achieved in 73.7% of the patients, with average preprocedural and postprocedural visual analog scale scores of 8.3 and 2.8, respectively. Fifty percent of patients reported recurrence of discomfort, and the average duration of the therapeutic effect in these patients was 5.3 weeks.