Extraspinal bone and soft-tissue tumors as a cause of sciatica - Clinical diagnosis and recommendations: Analysis of 32 cases

Study Design. Between 1982 and 1997, the authors treated 32 patients with s ciatica who subsequently were found to have a tumor along the extraspinal c ourse of the sciatic nerve. Summary of Background Data. Extraspinal compression of the sciatic nerve by a tumor is a rare cause of sciatica. Signs and symptoms overlap those of t he more common causes of sciatica (i.e,, herniated disc and spinal stenosis ). Objective. To characterize the unique clinical presentation of these patien ts and to formulate guidelines that may lead to early diagnosis. Methods. All pertinent clinical data and studies were reviewed retrospectiv ely, and standard demographic data were collected for analysis. Results, These patients typically sought treatment for an insidious onset o f sciatic pain that was constant, progressive, and unresponsive to change i n position or bed rest. The mean time to final diagnosis was 11.9 months (m edian, 6 months). Seventeen patients were able to locate their pain to a sp ecific point along the extraspinal course of the sciatic pain, and a mass w as noted in 13 patients. Eighteen of these tumors were in the pelvis, 10 in the thigh, and 4 in the popliteal fossa and calf. Conclusions. A high index of clinical suspicion is the key to early diagnos is of bone or soft-tissue tumors as a cause of sciatica; special attention should be given to pain pattern, physical examination of the entire course of the sciatic nerve, and selection of proper imaging studies. Routine ante roposterior plain radiography of the pelvis as part of the initial imaging screening process is recommended.