Background & aim: Schwannomas are benign and slowly growing nerve sheath tumors which are usually solitary and encapsulated. They may arise from any peripheral nerve containing Schwann cells including distal portions of cranial nerves. Here we are reporting a case of Schwannoma presenting as SCIATICA.Case: A 30 years old woman admitted as severe chronic right lower limb pain, her complain was SCIATICA with an irregular prominent 15*10 cm mass found on her right buttock. She had normal laboratory data and MRI demonstrated extra muscular mass in posterior of mid zone of right thigh that was iso-signal in T1W1 and hyper-signal in T2W2.The patient underwent operation and sciatic nerve explored via posterior tight and unique neural branch of mass dissociated of sciatic and mass resected. Pathology report confirmed Schwannoma in the patient.Conclusion: In patients with sciatic pain, schwannoma nerve is one of the differential diagnosis and it needs to be considered in assessing of patients.

Dear Editor: Low back pain and SCIATICA have been considered as the common morbidities of human kind throughout the history. The explanation of the etiology has been changed during the centuries and still remains a dilemma. Reviewing ancient theories may lead to novel findings about the etiology and its better treatments.

This case report pertains to a man aged 42 years who presented with pain along the sciatic nerve distribution and difficulty in walking 15 years after susfaining a shrapnel injury in the gluteal region in the Iran - Iraq war; and was being investigated for discopathy. In the CT Scan and other investigations, no evidence of a herniated disc was present except for a mass in the pelvic region for which the patient was referred to the surgeon. On exanination, a pulsatile mass in the gluteal region was felt. Sonography and angiography confmned a pseudoaneurysm of the gluteal artery which dated back to a shrapnel injury years ago. The patient was scheduled for surgery, and after ligature of the right iliac internal and right gluteal arteries via a retroperitoneal and pelvic approach, and thenafter changing the position of the patient and gaining access to the pseudoaneurysm in the gluteal region, the pseudoaneurysm was evacuated and its pressure on the sciatic nerve released. This resulted in total disappearance of the patient s symptoms. In literature review, only six patients presenting with pain in the distribution of the sciatic nerve secondary to gluteal artery aneurysm could be found which world be discussed.

Herpes zoster is a rare cause of non-discogenic SCIATICA. A combination of case rarity and name similarity was nearly leading to an inopportune surgery in a 21 years old woman. The clinical presentation was completely similar to a cauda equina syndrome associated with urinary incontinence and bilateral leg involvement. Concurrently, lumbosacral imaging of another patient with exactly similar name in the picture archiving communications system (PACS) has shown a huge L5-1 disc herniation. Careful attention to all diverse causes of SCIATICA and identifying details of the images could prevent improper discectomy in our patient.

Background: Sciatic pain in association with lumbar disc herniation may require surgical intervention in the form of lumbar discectomy. Yet, the optimal time for this operation has not been specified in medical literature.Methods: In a Cross-sectional study, 147 patients (100 men and 47 women) with radiological and clinical signs of L4-L5 or L5-S1 disc herniation were entered to our registry prior to March 2009. They were all examined, diagnosed and operated on (lumbar discectomy) in Ghaem General Hospital, Mashhad, Iran. Patients were all subsequently followed for one year. The follow-up continued in a number of 126 cases, whose satisfaction was rated via phone interview for an extra year. The patients’ assessments were implemented employing three scaling systems, both before and following lumbar discectomy, to name the Modified Oswestry Disability Index (MODI), Visual Analogue Scale (VAS) and Prolo Functional Economic Outcome Rating Scale (PORS). The former two were used for pre-operative and post-operative assessments whereas the latter was applied during the first year of follow-up. The focus of the investigation during second year was on patients’ satisfaction.Results: Mean age of our cases were 34±7.4 years. According to the duration of the SCIATICA, patients were divided into 4 groups. <3 months, 3 to <6 month, 6 to <12 months and >12 months. Statistical analysis revealed a significant difference between patients having undergone lumber discectomy with a history of SCIATICA for less and more than three month before the operation in terms of pre-and post-operative visual Analogue Scale (P=0.022). However, there could be found no such disparity in other clinical scores (P=0.63 for MODI, P=0.85 for Prolo scale and P=0.73 for satisfaction).Conclusion: Patients with less than three months of SCIATICA may seem to enjoy a better clinical outcome after one year, there could be found no correlation between the duration of SCIATICA and the satisfaction after two years.

Background: Little evidence exists on the diagnostic accuracy of clinical presentation in distinguishing the type of herniation in patients with lumbar disc disease. This study was undertaken to examine the correlation between clinical features and herniation type in lumbar disc hernia. Methods: One hundred and fifty consecutive candidates for lumbar discectomy were examined. The initial assessments, including location and duration of pain, neurological examination, and straight leg-raising (SLR) tests were performed by an independent observer who was unaware of the final diagnosis. Intraoperatively, all patients were assessed by a single neurosurgeon for the presence of disc protrusion or extrusion. Results: Among 90 men and 60 women (mean age: 41.4, range: 18 – 75 year), 85 patients had disc protrusion and 65 had extruded disc. Patients with radicular pain alone and those who experienced a resolution of low back pain followed by an increased severity of radicular pain were 6.5 (P < 0.002) and 10.2 (P < 0.000) times more likely to have an extruded disc, respectively. The mean preoperative duration among the group of patients with extruded disc (11 weeks) was significantly shorter than the protruded ones (18.6 weeks) (P < 0.005). Among all subjects, 103 patients showed neurological abnormalities. There was no association between the presence of neurological deficits and the type of herniation (P > 0.005). In patients with positive crossed straight leg-raising (N = 43), 33 had extruded disc and 10 had protruded disc. The positive crossed SLR test correlated significantly with the type of herniation (relative risk = 2.56, P < 0.000, and X2 = 27.4). Conclusion: In the lumbar disc disease, there were three groups of patients: a) those with radicular pain alone, b) those who experienced an increased severity of radicular pain followed by resolution of back pain, and c) patients with positive crossed SLR test who had a high probability of harboring an extruded disc. There was no significant association between the neurological abnormalities and the type of herniation.

Non-discogenic SCIATICA can be caused by any lesion along the course of the lumbosacral nerve roots and sciatic nerve. We aim to present a rare case of refractory SCIATICA in an otherwise healthy 25-year-old man. He complained of left leg pain without significant back pain. Extensor hallucis longus muscle was weak on the left side with limited straight leg rising. On magnetic resonance imaging, a space-occupying lesion resembling a sequestrated disc was noted that after surgical decompression, epidural varicosis was demonstrated.