• Journal of Korean Neurosurgical Society
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• v.67 no.2
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• pp.217-226
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• 2024

Objective : The efficacy of sciatic nerve decompression via transgluteal approach for entrapment of the sciatic nerve at the greater sciatic notch, called piriformis syndrome, and factors affecting the surgical outcome were analyzed. Methods : The outcome of pain reduction was analyzed in 81 patients with sciatic nerve entrapment who underwent decompression through a transgluteal approach. The patients were followed up for at least 6 months. The degree of pain reduction was analyzed using a numerical rating scale-11 (NRS-11) score and percent pain relief before and after last follow-up following surgery. Success was defined by at least 50% reduction in pain measured via NRS-11. To assess the degree of subjective satisfaction, a 10-point Likert scale was used. In addition, demographic characteristics, anatomical variations, and variations in surgical technique involving sacrotuberous ligamentectomy were analyzed as factors that affect the surgical outcome. Results : At a follow-up of 17.5±12.5 months, sciatic nerve decompression was successful in 50 of 81 patients (61.7%), and the pain relief rate was 43.9±34.17. Subjective improvement based on a 10-point Likert scale was 4.90±3.43. Among the factors that affect the surgical outcome, only additional division of the sacrotuberous ligament during piriformis muscle resection played a significant role. The success rate was higher in the scarotuberous ligementectomy group (79.4%) than in the non-resection group (42.6%), resulting in statistically significant difference based on average NRS-11 score, percent pain relief, and subjective improvement (p<0.05, independent t-test). Conclusion : Sciatic nerve decompression is effective in pain relief in chronic sciatica due to sciatic nerve entrapment at the greater sciatic notch. Its effect was further enhanced by circumferential dissection of the sciatic nerve based on the compartment formed by the piriformis muscle and the sacrotuberous ligament in the greater sciatic notch.

• The Korean Journal of Pain
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• v.22 no.2
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• pp.186-190
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• 2009

Sciatic nerve block is frequently used for anesthesia or analgesia during lower leg surgery or chronic lower leg pain syndrome. Recently, a lot of ultrasound-guided peripheral nerve block has been reported because there are several benefits compared to blind technique. We performed ultrasound-guided right sciatic nerve block successfully to the patient who has been suffering from right buttock pain after previous radiation therapy.

• Journal of Korean Neurosurgical Society
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• v.57 no.2
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• pp.123-126
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• 2015

A rare case of chronic pain of entrapment neuropathy of the sciatic nerve successfully relieved by surgical decompression is presented. A 71-year-old male suffered a chronic right buttock pain of duration of 7 years which radiating to the right distal leg and foot. His pain developed gradually over one year after underwenting drainage for the gluteal abscess seven years ago. A cramping buttock and intermittently radiating pain to his right foot on sitting, walking, and voiding did not respond to conventional treatment. An MRI suggested a post-inflammatory adhesion encroaching the proximal course of the sciatic nerve beneath the piriformis as it emerges from the sciatic notch. Upon exploration of the sciatic nerve, a fibrotic tendinous scar beneath the piriformis was found and released proximally to the sciatic notch. His chronic intractable pain was completely relieved within days after the decompression. However, thigh weakness and hypesthesia of the foot did not improve. This case suggest a need for of more prompt investigation and decompression of the chronic sciatic entrapment neuropathy which does not improve clinically or electrically over several months.

• Journal of International Academy of Physical Therapy Research
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• v.3 no.1
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• pp.345-355
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• 2012

This study purposed to examine the effect of low power laser on pain response and axonal regeneration. In order to prepare peripheral nerve injury models, we crushed the sciatic nerve of Sprague-Dawley rats and treated them with low power laser for 21 days. The rats were divided into 4 groups: normal group(n=10); control group(n=10) without any treatment after the induction of sciatic nerve crush injury; experimental group I(n=10) treated with low power laser(0.21$mJ/mm^2$) after the induction of sciatic nerve crush injury; and experimental group II(n=10) treated with low power laser(5.25$mJ/mm^2$) after the induction of sciatic nerve crush injury. We measured spontaneous pain behavior(paw withdrawal latency test) and mechanical allodynia(von Frey filament test) for evaluating pain behavioral response, and measured the sciatic function index for evaluating the functional recovery of peripheral nerve before the induction of sciatic nerve crush injury and on day 1, 7, 14 and 21 after the induction. After the experiment was completed, changes in the H & E stain and toluidine blue stain were examined histopathologically, and changes in MAG(myelin associated glycoprotein) and c-fos were examined immunohistologically. According to the results of this study, when low power laser was applied to rat models with sciatic nerve crush injury for 21 days and the results were examined through pain behavior evaluation and neurobehavioral, histopathological and immunohistological analyses, low power laser was found to affect pain response and axonal regeneration in both experimental group I and experimental group II. Moreover, the effect on pain response and axonal regeneration was more positive in experimental group I to which output 0.21$mJ/mm^2$ was applied than in experimental group II to which 5.25$mJ/mm^2$ was applied.

• The Korean Journal of Pain
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• v.33 no.1
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• pp.13-22
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• 2020

Background: The continuous search for a novel neuropathic pain drug with few or no side effects has been a main focus of researchers for decades. This study investigated the antinociceptive and neuroprotective effects of bromelain in sciatic nerve ligation-induced neuropathic pain in Wistar rats. Methods: Forty-eight Wistar rats randomly divided into eight groups comprised of six animals each were used for this study. Peripheral neuropathy was induced via chronic constriction of the common sciatic nerve. Thermal hyperalgesic and mechanical allodynia were assessed using a hotplate and von Frey filaments, respectively. The functional recovery and structural architecture of the ligated sciatic nerve were evaluated using the sciatic functional index test and a histological examination of the transverse section of the sciatic nerve. The neuroprotective effects of bromelain were investigated in the proximal sciatic nerve tissue after 21 days of treatment. Results: Bromelain significantly (P < 0.05) attenuated both the thermal hyperalgesia and mechanical allodynic indices of neuropathic pain. There were improvements in sciatic function and structural integrity in rats treated with bromelain. These rats showed significant (P < 0.05) increases in sciatic nerve nuclear transcription factors (nuclear factor erythroid-derived-2-related factors-1 [NrF-1] and NrF-2), antioxidant enzymes (superoxide dismutase and glutathione), and reduced membranelipid peroxidation compared with the ligated control group. Conclusions: This study suggest that bromelain mitigated neuropathic pain by enhancing the activities of nuclear transcription factors (NrF-1 and NrF-2) which increases the antioxidant defense system that abolish neuronal stress and structural disorganization.

• Journal of the Korean Academy of Clinical Electrophysiology
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• v.6 no.1
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• pp.17-30
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• 2008

This study was investigated the effects of pain and functional recovery when low frequency electrical stimulation and aquatic exercise applied to sciatic nerve injured rats. The rats were assigned into four groups; Group I(n=20, control group), Group II(n=20, low frequency electrical stimulation group), Group III(n=20, aquatic exercise group), Group (n=20, applied low frequency electrical stimulation and aquaatic exercise group). Each IV group measured hot plate examination, sciatic nerve functional index(SFI), c-fos.. In hot plate examination, group II, IV showed effect than group Iat 14 days after injured(p<0.01) and group III, Ⅳ showed effect than group I at 21, 28 days after in-jured(p<0.01, p<0.001). In SFI, group II, III, IV showed effect II, III, IV than group I and group IV showed effect than group II at 14, 21 days after injured(p<0.001). group II, III, IV showed effect than group I at 28 days after injured(II = p<0.01, III and IV = p<0.001). Effects of pain and function recovery when low frequency electrical stimulation and aqua-exercise applied to sciatic nerve injured rats, group Ⅳ were most effected to sciatic nerve injured rats. As well as group II and III were effected to sciatic nerve injured rats.

• The Journal of Korean Medicine
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• v.30 no.3
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• pp.28-38
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• 2009

Background : Peripheral nerve injuries are a commonly encountered clinical problem and often result in a chronic pain and severe functional deficits. Objective : The aim of this study was to evaluate the effects of Gentianae Macrophyllae Radix (G. M. Radix) on the pain control and the recovery of the locomotor function that results from the sciatic crushed nerve injury in rats. Method : Using rats, we crushed their sciatic nerve, and then orally administered the aqueous extract of G. M. Radix. The effects of G. M. Radix on the recovery locomotor function were investigated by walking track analysis. The effects of G. M. Radix on pain control were investigated by brain-derived neurotrophic factor (BDNF) expression in the sciatic nerve, and c-Fos expression in the paraventricular nucleus (PVN) of the hypothalamus and in the ventrolateral periaqueductal gray (vlPAG). Result : G. M. RADIX facilitates motor function from the locomotor deficit, and thereby increased BDNF expression and suppressed painful stimuli in the PVN and vlPAG after sciatic crushed nerve injury. Conclusion : It is suggested that G. M. Radix might aid recovery locomotor function and control pain after sciatic crushed nerve injury. Further studies on identifying specific the component in G.M. Radix associated with enhanced neural activity in the peripheral nerve injury may be helpful to develop therapeutic strategies for the treatment of peripheral nerve injury.

• The Journal of Korean Medicine
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• v.31 no.3
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• pp.66-78
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• 2010

Background: Peripheral nerve injuries are a commonly-encountered clinical problem and often result in a chronic pain and severe functional deficits. Objectives: The aim of this study was to evaluate the effects of acupuncture on the descending pain and the recovery of the locomotor function that follows sciatic crushed nerve injury in rats. Method: In order to assess the effects of acupuncture on the descending pain and functional recovery, we investigated the walking track analysis, brain-derived neurotrophic factor (BDNF) and its receptor tyrosine receptor kinase B (TrkB) expression in the sciatic nerve, and on the expressions of c-Fos and nitric oxide synthase in the paraventricular nucleus (PVN) of the hypothalamus and in the ventrolateral periaqueductal gray (vlPAG) region resulting from sciatic crushed nerve injury in rats. Results: Acupuncture treatment at Huantiao (GB30), Yanglingquan (GB34), and Weizhong (BL40) facilitated functional recovery. C-Fos and nitric oxide synthase expressions in the brain and BDNF and TrkB expressions in the sciatic nerve were decreased by acupuncture treatment. The most potent effects of acupuncture were observed at the GB30 acupoint. Conclusion: It is possible that acupuncture can be used for pain control and functional recovery from sciatic nerve injury.

• Journal of Korean Foot and Ankle Society
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• v.20 no.3
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• pp.135-139
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• 2016

Purpose: Modified Mau and Akin osteotomy for hallux valgus is followed by moderate to severe postoperative pain. Ultrasound-guided sciatic nerve block can be an effective option for pain control. We attempted to evaluate the efficacy of the ultrasound-guided sciatic nerve block in controlling postoperative pain. Materials and Methods: The charts of 59 consecutive patients were retrospectively reviewed between December 2014 and August 2015. Twenty-eight patients (the patient group) has received the ultrasound-guided sciatic nerve block after surgery, and 31 patients (the control group) has not received such procedure. The primary outcome was the satisfaction scale for postoperative pain control and postoperative visual analogue scale (VAS) score. Results: The VAS score at postoperative day one was significantly lower in the patient group than in the control group. The satisfaction scale for pain control for postoperative 1 day was significantly different between the two groups. In patient group, most patients have rated positively ('strongly agree' 42.9%, 'agree' 42.9%); however, in the control group, the rating scales were distributed relatively negatively ('strongly agree' 9.7%, 'agree' 22.6%, 'neutral' 29.0%, 'disagree' 25.8%, 'strongly disagree' 12.9%). The number of postoperative rescue analgesics injection was significantly lower in the patient group than in the control group. Conclusion: Postoperative ultrasound-guided sciatic nerve block was effective for pain relief after hallux valgus surgery.

• The Korean Journal of Pain
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• v.2 no.1
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• pp.72-77
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• 1989

Sciatic neuralgia has been considered as the symptom of herniated lumbar disk. but disk disease is not the only causes of sciatic neuralgia. Sciatic neuralgia uncombined with disk disease in thought to be a sign of myofascial syndrome of the piriform is muscle. Local anesthetic injection into piriform is muscle is recommended for the therapeutic treatment of sciatica without lumbago.