虽然坐骨神经痛的大多数病例是由下背部的退行性疾病引起的,有些病例是由于髋关节和骨盆区域的状况造成的。与妊娠或分娩有关的坐骨神经痛也提出了独特的考虑因素。
一名37岁的非洲裔美国妇女,有高血压和多囊卵巢综合征病史,在医院门诊就诊,有7周的腰痛病史,并在分娩期间开始向右下肢放射。脊医做了一个简短的护理试验,然而,当病人的症状恶化,订购腰椎X光片,其次是腰椎磁共振成像(MRI),都是正常的.脊椎按摩师随后订购了髋部X光片,暗示为坐骨骨软骨瘤,并将病人转诊给骨科肿瘤科医生.MRI结果与伴有外膜滑囊炎和坐骨神经肿块效应的骨软骨瘤相符。患者最初选择了保守治疗,包括法氏囊抽吸和治疗性注射。尽管最初的救济,症状最终复发。病人选择接受手术切除,一个积极的结果。
在这种情况下,导致骨软骨瘤诊断的关键特征包括关注患者报告的症状和病史。尽管保守治疗,症状恶化,缺乏腰椎影像学的解释性发现。当坐骨神经痛的临床特征不能归因于腰椎病因时,这种情况突出了评估髋关节和骨盆的好处。此病例还说明了脊医在综合卫生系统中工作的作用,以促进及时的成像和转诊以解决具有挑战性的诊断。
While most cases of sciatica result from degenerative conditions of the low back, some cases result from conditions of the hip and pelvic region. Sciatica developing in relation to pregnancy or labor also presents unique considerations.
A 37-year-old African American woman with a history of hypertension and polycystic ovary syndrome presented to a chiropractor at a hospital-based outpatient clinic with a seven-week history of low back pain with radiation into the right lower extremity which began during labor. The chiropractor performed a brief trial of care, yet when the patient\'s symptoms worsened, ordered lumbar spine radiographs, followed by lumbar magnetic resonance imaging (MRI), which were both normal. The chiropractor then ordered hip radiographs, which were suggestive of ischial osteochondroma, and referred the patient to an orthopedic oncologist. MRI findings were compatible with an osteochondroma with associated adventitial bursitis and mass effect on the sciatic nerve. The patient initially chose conservative management with bursa aspiration and therapeutic injection. Despite initial relief, there was eventual return of symptoms. The patient elected to undergo surgical removal, with a positive outcome.
The key distinguishing features that led to a diagnosis of osteochondroma in this
case included attention to the patient-reported symptoms and history, worsening of symptoms despite conservative care, and lack of explanatory findings on lumbar imaging. This
case highlights the benefit of evaluating the hip and pelvis when the clinical features of sciatica cannot be ascribed to a lumbar etiology. This
case also illustrates the role of a chiropractor working in an integrative health system to facilitate timely imaging and referrals to resolve a challenging diagnosis.