SCIATIC TENSION SIGNS AND LUMBAR DISC HERNIATION

Study Design. Sciatic stretch maneuvers designed to elicit signs of ne rve root compressions secondary to lumbar disc herniation were evaluat ed in a prospective manner to correlate intraoperative evaluation of s urgical pathology regarding level and anatomic location and proximity of the herniated disc to the nerve root. Objectives. To study the corr elation between specific diagnostic maneuvers of sciatic stretch and a natomic location or level of lumbar disc pathology. Summary of Backgro und Data. Maneuvers of sciatic tension, such as the straight leg lift, the well leg lift, Lasegue's sign, and the bowstring sign, have been used since the 1.880s as a diagnostic maneuver to separate sciatica fr om hip pain. Methods. Fifty consecutive candidates with clinical and r adiographic evidence of disc herniation were examined. Initial physica l examination included evaluation of sciatic tension signs using the s traight leg lift, cross leg lift, Lasegue's sign, and the bowstring si gn. The presence of lumbar disc herniation was confirmed radiographica lly. Intraoperatively, the 50 patients were assessed for anatomic loca tion of disc herniation and the presence of disc protrusion or extrusi on. Results. The straight leg lift was the most sensitive preoperative physical diagnostic sign for correlating intraoperative pathology of lumbar disc herniation. Conclusions. Physical diagnostic maneuvers for evaluating sciatic tension in patients with documented lumbar disc he rniation have a high correlation with surgical pathology. These diagno stic signs of sciatic stretch can be reliable guides that lead to more aggressive modes of evaluation. No correlation was found between spec ific sciatic stretch maneuvers regarding location of disc herniation r elative to the nerve root.