Results of Neurolysis for the Treatment of Neuropathic Pain in Patients with Sciatic Nerve Injury. Case Report
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Published:
Apr 24, 2023
Keywords:
Sciatic neurolysis, neuropathic pain, SF-36 questionnaire, sciatic nerve injury
Main Article Content
Abstract
Introduction: Sciatic nerve injury may cause paresthesias and hypoesthesias, severe neuropathic pain, and paralysis. Neurolysis can improve function, pain, and quality of life for these patients. The objective of this paper is to evaluate the clinical-functional outcomes of a series of patients with neuropathic pain due to sciatic nerve injury that was refractory to conservative treatment in whom neurolysis was performed.
Materials and Methods: A retrospective case series of patients operated on for neurolysis of the greater sciatic nerve between March 2009 and June 2018 was analyzed. Preoperative and postoperative pain were evaluated using the visual analog scale (VAS) and the Likert scale. The type of postoperative pain was evaluated using the DN4 questionnaire, and the health-related quality of life was measured with the SF-36 questionnaire.
Results: Eight patients were included. All patients evolved with a notable improvement in pain, with an average of 3 and 1.88 points on the VAS and Likert scales, respectively. The mean follow-up was 32 months (range 14–66). The DN4 questionnaire showed an average of 3.75 points (range 2–7). According to the SF-36, “Physical Health” was the variable with the worst results, with an average of 30.15.
Conclusions: Sciatic nerve neurolysis in patients with neuropathic pain due to sciatic nerve injury and poor response to conservative treatment may improve pain and quality of life.
Materials and Methods: A retrospective case series of patients operated on for neurolysis of the greater sciatic nerve between March 2009 and June 2018 was analyzed. Preoperative and postoperative pain were evaluated using the visual analog scale (VAS) and the Likert scale. The type of postoperative pain was evaluated using the DN4 questionnaire, and the health-related quality of life was measured with the SF-36 questionnaire.
Results: Eight patients were included. All patients evolved with a notable improvement in pain, with an average of 3 and 1.88 points on the VAS and Likert scales, respectively. The mean follow-up was 32 months (range 14–66). The DN4 questionnaire showed an average of 3.75 points (range 2–7). According to the SF-36, “Physical Health” was the variable with the worst results, with an average of 30.15.
Conclusions: Sciatic nerve neurolysis in patients with neuropathic pain due to sciatic nerve injury and poor response to conservative treatment may improve pain and quality of life.
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How to Cite
García Bistolfi, M., Magno, G., Saralegui, P., Gallucci, G. L., De Carli, P., Donndorff, A., Rellán, I., & Boretto, J. G. (2023). Results of Neurolysis for the Treatment of Neuropathic Pain in Patients with Sciatic Nerve Injury. Case Report. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(2), 156-163. https://doi.org/10.15417/issn.1852-7434.2023.88.2.1380
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Clinical Research
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neuropathic pain in patients with a sciatic nerve palsy after total hip replacement. Bone Joint J 2013;95-B(1):20-2.
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neuropathy and sciatic nerve tumors. HSS J 2006;2(2):181-7. https://doi.org/10.1007/s11420-006-9018-z
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total hip arthroplasty: What are the outcomes? J Arthroplasty 2017;32(4):1335-9. https://doi.org/10.1016/j.arth.2016.10.032
10. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, et al. Comparison of pain syndromes
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(DN4). Pain 2005;114(1-2):29-36. https://doi.org/10.1016/j.pain.2004.12.010
11. VanDenKerkhof EG, Stitt L, Clark AJ, Gordon A, Lynch M, Morley-Forster PK, et al. Sensitivity of the DN4 in
screening for neuropathic pain syndromes. Clin J Pain 2018;34(1):30-6. https://doi.org/10.1097/AJP.0000000000000512
12. Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, et al. Validating the SF-36 health survey
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successfully validated for local outcome research. J Clin Epidemiol 2008;61(12):1279-84.e6. https://doi.org/10.1016/j.jclinepi.2008.05.004
14. Uskova AA, Plakseychuk A, Chelly JE. The role of surgery in postoperative nerve injuries following total hip
replacement. J Clin Anesth 2010;22(4):285-93. https://doi.org/10.1016/j.jclinane.2009.10.006. Erratum in: J Clin
Anesth. 2010;22(5):397. PMID: 20522361
15. May O, Girard J, Hurtevent JF, Migaud H. Delayed, transient sciatic nerve palsy after primary cementless hip
arthroplasty: a report of two cases. J Bone Joint Surg Br 2008;90(5):674-6. https://doi.org/10.1302/0301-620X.90B5.19536
16. De Azcuénaga MA, De Azcuénaga MV. Tratamiento quirúrgico actual de las fracturas del acetábulo producidas por traumatismos de alta energía. Rev Asoc Arg Ortop Traumatol 2000;65(3):196-200. Disponible en:
https://www.aaot.org.ar/revista/1993_2002/2000/2000_3/650304.pdf
17. Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol 2010;9(8):807-19. https://doi.org/10.1016/S1474-4422(10)70143-5
18. Harden RN, Oaklander AL, Burton AW, Perez RS, Richardson K, Swan M, et al. Reflex sympathetic dystrophy
syndrome association. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. Pain Med 2013;14(2):180-229. https://doi.org/10.1111/pme.12033
19. Pritchett JW. Outcome of surgery for nerve injury following total hip arthroplasty. Int Orthop 2018;42(2):289-95. https://doi.org/10.1007/s00264-017-3724-7
palsy associated with total hip arthroplasty. Bone Joint J 2015;97-B(10):1345-9. https://doi.org/10.1302/0301-620X.97B10.35590
2. Kyriacou S, Pastides PS, Singh VK, Jeyaseelan L, Sinisi M, Fox M. Exploration and neurolysis for the treatment of
neuropathic pain in patients with a sciatic nerve palsy after total hip replacement. Bone Joint J 2013;95-B(1):20-2.
https://doi.org/10.1302/0301-620X.95B1.29740
3. Yacoubian SV, Sah AP, Estok DM 2nd. Incidence of sciatic nerve palsy after revision hip arthroplasty through a
posterior approach. J Arthroplasty 2010;25(1):31-4. https://doi.org/10.1016/j.arth.2008.11.101
4. Buttaro M, Pérez de Nucci E, Piccaluga F. Prevalencia de lesiones neurológicas en 2874 artroplastias totales de
cadera. Rev Asoc Argent Ortop Traumatol 2006;71(3):205-10. Disponible en: http://aaot.org.ar/revista/2006/n3_vol71/art3.pdf
5. Piccaluga F. Lesiones neurológicas asociadas al reemplazo total de cadera. Rev Asoc Arg Ortop Traumatol
1993;58(3):344-51. Disponible en: https://www.aaot.org.ar/revista/1993_2002/1993/1993_3/580310.pdf
6. Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 2005;87(12):2619-25. https://doi.org/10.2106/JBJS.C.01564
7. Kim DH, Murovic JA, Tiel R, Kline DG. Management and outcomes in 353 surgically treated sciatic nerve lesions.
J Neurosurg 2004;101(1):8-17. https://doi.org/10.3171/jns.2004.101.1.0008
8. Feinberg J, Sethi S. Sciatic neuropathy: case report and discussion of the literature on postoperative sciatic
neuropathy and sciatic nerve tumors. HSS J 2006;2(2):181-7. https://doi.org/10.1007/s11420-006-9018-z
9. Chughtai M, Khlopas A, Gwam CU, Elmallah RK, Thomas M, Nace J, et al. Nerve decompression surgery after
total hip arthroplasty: What are the outcomes? J Arthroplasty 2017;32(4):1335-9. https://doi.org/10.1016/j.arth.2016.10.032
10. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, et al. Comparison of pain syndromes
associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire
(DN4). Pain 2005;114(1-2):29-36. https://doi.org/10.1016/j.pain.2004.12.010
11. VanDenKerkhof EG, Stitt L, Clark AJ, Gordon A, Lynch M, Morley-Forster PK, et al. Sensitivity of the DN4 in
screening for neuropathic pain syndromes. Clin J Pain 2018;34(1):30-6. https://doi.org/10.1097/AJP.0000000000000512
12. Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, et al. Validating the SF-36 health survey
questionnaire: new outcome measure for primary care. BMJ 1992;305(6846):160-4. https://doi.org/10.1136/bmj.305.6846.160
13. Augustovski FA, Lewin G, García-Elorrio E, Rubinstein A. The Argentine–Spanish SF-36 Health Survey was
successfully validated for local outcome research. J Clin Epidemiol 2008;61(12):1279-84.e6. https://doi.org/10.1016/j.jclinepi.2008.05.004
14. Uskova AA, Plakseychuk A, Chelly JE. The role of surgery in postoperative nerve injuries following total hip
replacement. J Clin Anesth 2010;22(4):285-93. https://doi.org/10.1016/j.jclinane.2009.10.006. Erratum in: J Clin
Anesth. 2010;22(5):397. PMID: 20522361
15. May O, Girard J, Hurtevent JF, Migaud H. Delayed, transient sciatic nerve palsy after primary cementless hip
arthroplasty: a report of two cases. J Bone Joint Surg Br 2008;90(5):674-6. https://doi.org/10.1302/0301-620X.90B5.19536
16. De Azcuénaga MA, De Azcuénaga MV. Tratamiento quirúrgico actual de las fracturas del acetábulo producidas por traumatismos de alta energía. Rev Asoc Arg Ortop Traumatol 2000;65(3):196-200. Disponible en:
https://www.aaot.org.ar/revista/1993_2002/2000/2000_3/650304.pdf
17. Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol 2010;9(8):807-19. https://doi.org/10.1016/S1474-4422(10)70143-5
18. Harden RN, Oaklander AL, Burton AW, Perez RS, Richardson K, Swan M, et al. Reflex sympathetic dystrophy
syndrome association. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. Pain Med 2013;14(2):180-229. https://doi.org/10.1111/pme.12033
19. Pritchett JW. Outcome of surgery for nerve injury following total hip arthroplasty. Int Orthop 2018;42(2):289-95. https://doi.org/10.1007/s00264-017-3724-7