Sciatica Research Today is a free monthly online journal that collates and summarizes the latest research about Sciatica, including details on treatment, prevention, medication.

Tumor Necrosis alpha-blocking Agent (Etanercept): A Triple Blind Randomized Controlled Trial of its Use in Treatment of Sciatica.

Okoro T, Tafazal SI, Longworth S, Sell PJ

Departments of *Orthopaedics and Trauma daggerOrthopaedics, University Hospitals Leicester, Leicester, UK.

STUDY DESIGN: Triple blind randomized controlled study. OBJECTIVE: To establish the treatment effect of etanercept in acute sciatica secondary to lumbar disc herniation. SUMMARY OF BACKGROUND DATA: Etanercept is a selective competitor of tumor necrosis factor-alpha which is a proinflammatory cytokine. It is currently used alone or in combination with other medication for the treatment of chronic inflammatory disease. METHODS: Inclusion criteria were acute unilateral radicular leg pain secondary to herniated nucleus pulposus confirmed on magnetic resonance imaging scan. Exclusions were previous back surgery, spinal stenosis and any contraindications to the use of etanercept such as immunosuppression. The patient, the injector, and assessor were blinded to the agent being used. Follow-up was at 6 weeks and 3 months posttreatment. Oswestry disability index and visual analog scores were among the assessment criteria. RESULTS: Fifteen patients were recruited in a 4 years period with a 3 months follow-up of 80%. The etanercept group had 8 patients whereas the placebo group had 7. The average Oswestry disability index for the etanercept group preintervention was higher than that in the placebo group (53.6 vs. 50.4) and this remained the same after 6 weeks (46.1 vs. 31.2) and 3 months of follow-up (37 vs. 35). Visual analog score was also higher in the etanercept group versus placebo; preinjection (8.6 vs. 7.4), 6 weeks (5.0 vs. 3.8), and 3 months (4.8 vs. 4.5). CONCLUSIONS: Small numbers of trial participants limited statistical analysis. The trend appears to show no benefit to the use of etanercept over placebo in the pharmacologic treatment of sciatica.

Published 5 February 2010 in J Spinal Disord Tech, 23(1): 74-7.
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Articles on Sciatica published 3 February 2010:

Extraspinal sciatica revealing late metastatic disease from parotid carcinoma.   Joint Bone Spine, 77(1): 64-66.

Sciatica is a clinical symptom usually caused by a disk herniation and less often by other conditions such as tumors, infections, or inflammatory diseases. We report the case of a woman in whom sciatica led to the identification of a large pelvic metastasis from a carcinoma of the parotid gland. [Abstract] [Full-text]

Microvascular system of the lumbar dorsal root ganglia in rats. Part II: neurogenic control of intraganglionic blood flow.   J Neurosurg Spine, 12(2): 203-9.

Object The dorsal root ganglion (DRG) should not be overlooked when considering the mechanism of low-back pain and sciatica, so it is important to understand the morphological features of the vascular system supplying the DRG. However, the neurogenic control of intraganglionic blood flow has received little attention in the past. The authors used an immunohistochemical technique to investigate the presence and distribution of autonomic and sensory nerves in blood vessels of the DRG. Methods Ten ... [Abstract] [Full-text]

Articles on Sciatica published 25 January 2010:

Two screening tests for urinary voiding dysfunction used in 209 consecutive patients undergoing lumbar spine operations.   Scand J Urol Nephrol.

Abstract Objective. A study of the prevalence of urinary voiding dysfunction was carried out preoperatively in 209 patients undergoing lumbar spine operations, using two non-invasive screening tests: free uroflowmetry and ultrasound measurement of residual urine. The value of using the two urodynamic screening tests in the evaluation of a larger group of patients with sciatica from disc lesions or spinal stenosis has not been published as an article before. Material and methods. In 209 ... [Abstract] [Full-text]

Articles on Sciatica published 21 January 2010:

Iatrogenic pseudoaneurysm of the superior gluteal artery presenting as pelvic mass with foot drop and sciatica: case report and review of literature.   Vasc Endovascular Surg, 44(1): 64-8.

We report an unusual case of a pseudoaneurysm of the superior gluteal artery as a complication of bone marrow biopsy. A 51-year-old man presented with sciatic pain and foot drop after undergoing bone marrow biopsy and was initially diagnosed as having degenerative disc disease based on his past medical history. Pelvic magnetic resonance imaging (MRI) revealed a large heterogeneous mass suggestive of a neurogenic tumor, but pulsatile blood was instead encountered during computed tomography ... [Abstract] [Full-text]

Knockdown of L calcium channel subtypes: differential effects in neuropathic pain.   J Neurosci, 30(3): 1073-85.

The maintenance of chronic pain states requires the regulation of gene expression, which relies on an influx of calcium. Calcium influx through neuronal L-type voltage-gated calcium channels (LTCs) plays a pivotal role in excitation-transcription coupling, but the involvement of LTCs in chronic pain remains unclear. We used a peptide nucleic acid (transportan 10-PNA conjugates)-based antisense strategy to investigate the role of the LTC subtypes Ca(V)1.2 and Ca(V)1.3 in long-term pain ... [Abstract] [Full-text]

Gender differences in self-rated health and mortality association: role of pain-inducing musculoskeletal disorders.   J Womens Health (Larchmt), 19(1): 109-16.

AIMS: We aimed to examine whether pain-inducing musculoskeletal disorders might explain the gender difference in the strength of the self-rated health (SRH)-mortality association. METHODS: We pooled data from two National Health and Nutrition Examination Surveys (conducted in 1998 and 2001), which were linked to national mortality data of Korea using 13-digit unique personal identification numbers. There were 9,912 study participants, and 456 deaths were recorded (average length of follow-up = ... [Abstract] [Full-text]

Articles on Sciatica published 20 January 2010:

Parathyroid hormone 2 receptor is a functional marker of nociceptive myelinated fibers responsible for neuropathic pain.   J Neurochem, 112(2): 521-30.

We have previously demonstrated that parathyroid hormone 2 (PTH2) receptors are expressed in dorsal root ganglion (DRG) neurons and that its endogenous agonist tuberoinfundibular peptide of 39 residues (TIP39) causes nociceptive paw flexor responses after intraplantar administration. Here we found that the PTH2 receptor is selectively localized on myelinated A-, but not unmyelinated C-fibers using immunohistochemical labeling, based on PTH2 receptor expression on antibody N52-positive ... [Abstract] [Full-text]

Articles on Sciatica published 5 January 2010:

A rare reason of foot drop caused by primary diffuse large b-cell lymphoma of the sciatic nerve: case report.   Acta Neurochir (Wien), 152(1): 125-8.

INTRODUCTION: Primary central nervous system lymphomas account for 2% of all malignant lymphomas. Although the involvement of peripheral nerves has been previously described as a dissemination of systemic lymphomas or a direct extension to the nerve trunk from contiguous lymphomas, primary involvement of the sciatic nerve is extremely rare. CASE: To the best of our knowledge, the primary localization of lymphoma within sciatic nerve has been reported only nine times. We report, a very rare ... [Abstract] [Full-text]

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