ugh review of all previous scans and treatment history to rule out any condition that might have been missed. Patients without adequate scan information within the last 12 months underwent additional X-ray and MRI scanning. The investigators found that seven patients had torn disc related conditions (annular tears) and were subsequently treated successfully with spine surgery.

The remaining 232 patients then underwent MR neurography to evaluate the sciatic nerve. They found that 162 (69 percent) of patients had piriformis syndrome, while the remaining 31 percent had 15 other nerve, muscle or joint conditions at various locations not seen in standard MRI scans. Piriformis syndrome was also confirmed and/or treated by using Open MRI guided imaging, a procedure in which a specially designed MRI scanner guides deep injections of pain medication into the spine, muscles, or near nerves.

"For the last 70 years, sciatica has been thought to be caused by a herniated disc and treated as such," said Dr. J. Patrick Johnson, M.D., senior author of the study and the director of the Cedars-Sinai Institute for Spinal Disorders. "But our study shows that it is time for a major reassessment of how patients will be evaluated and treated for sciatica in the future particularly in those patients with no obvious disc damage who previously failed treatment."

Following their diagnoses with MR neurography, all patients received treatment that included spinal surgery, nerve or muscle surgery, open MR guided injections, or non-interventional pain management that included physical therapy and exercise. Among the 62 patients who needed surgery to correct piriformis syndrome, 82 percent had a good or excellent outcome, based on patients' responses to a standardized outcome questionnaire over a six-year period.

"Although sciatica is the most common condition treated by neurosurgeons, piriformis syndrome is not even mentioned in the majority of n
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Contact: Kelli Hanley
kelli.hanley@cshs.org
1-310-423-3674
Cedars-Sinai Medical Center
31-Jan-2005

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