NON DISCOGENIC SCIATICA MIMICKING DISORDERS : A DILEMMA FOR NEUROSURGEONS IN MAKING SURGICAL DECISIONS: A REPORT OF 81 PATIENTS FROM ALI INSTITUTE OF NEUROSCIENCES, IRFAN GENERAL HOSPITAL

Abstract

ABSTRACT

Introduction: The cause of sciatica is not always discogenic and majority of patients are misdiagnosed as having discogenic sciatica while the underlying non discogenic causes are overlooked. This study aimed at evaluating the frequency of non-discogenic sciatica in patients presenting with lumber radiculopathy.

Material & Methods: A prospective case series study was conducted from February 2022 to January 2023 at Ali Institute of Neurosciences, Irfan General Hospital Peshawar. Nonprobability convenience sampling technique was incorporated. A total of 624 patients were reported to the OPD with clinical presentations of sciatica out of which 81 patients were included after thorough subjective, objective, and radiological investigation. Data was analysed using SPSS version 26.

Results: Five hundred forty-three (87%) patients were diagnosed with discogenic sciatica while 81(13%) patients were categorized under non discogenic disorders causing radicular symptoms. Majority of the patients 51(63%) were males as compared to females 30(37%) in the non-discogenic group. Out of 81 cases diagnosed with non-discogenic sciatica,26 cases (32%) were due to spinal tumours, facet dysfunction 10(12%), piriformis syndrome6(7%), cluneal nerve disorder2(2%), quadratus lumborum dysfunction4(5%), osteoarthritis of the hip3(4%), peripheral nerve disorders 8(10%), sacroiliac joint 3(4%)  infections 10(13%),trauma to gluteal region 3(4%), pregnancy associated sciatica 2(2%), compressive neuropathy 4(5%).

Conclusion: There are a number of non-discogenic disorders causing symptoms of lumber radiculopathy. Identifying the underlying non discogenic cause is still challenging. Considering the possible pathologies, detailed history taking and objective examination along with diagnostic tests and investigations can lead to the identification of underlying pathologies and their management.

Key Words: lumber radiculopathy, non-discogenic, sciatica