Ali Akhaddar

• MD, IFAANS
• Head of Department at Mohammed V University

Aspergillosis of the paranasal sinuses is infrequent and usually involves the species Aspergillus fumigatus and A. flavus. The maxillary sinus is the most common sinus to be affected. Invasive cranio-orbital aspergillosis originating in the sphenoid sinus is rare and mostly occurs in immunocompromised patients with poor outcomes. We present a case...

The association of posterior ring apophysis separation (PRAS) with lumbar disc herniation (LDH) is uncommon and represents a true subgroup of disc herniation mainly seen in the adolescent population. The objective of this study was to describe a decade of experience in the care of adult patients with PRAS with LDH, giving particular attention to it...

This Atlas is the first reference Atlas covering exclusively all aspects of this multifaceted topic. It is designed to serve as a succinct appropriate resource for neurosurgeons, spinal surgeons, radiologists, neurologists, microbiologists, researchers and infectious disease specialists with an interest in cranio-cerebral and vertebro-medullary inf...

Background In cranial surgery, different foreign body (FB) materials are used and may be left intentionally or unintentionally in the surgical field after closure, inducing a foreign body granuloma (FBG). This is a rare complication in neurosurgery, but it may be a diagnostic dilemna with sometimes medico-legal implications. Methods We performed...

Here, we describe a new way to facilitate identification and memorization of some of the most important/critical cortical brain areas around the central sulcus (Rolandic fissure) using the arabic transcription of the name "Allah" (God in Islam). https://surgicalneurologyint.com/surgicalint-articles/a-new-learning-approach-for-identifying-cortical-...

Written and edited by leading international authorities in the field, this book provides an in-depth review of the knowledge of the lesions of the scalp and cranial vault, with emphasis on their accurate diagnosis and the medical and often multidisciplined surgical approach to treating these disease processes. It includes chapters, organized into...

Introduction: Intracranial chronic subdural hematomas are frequently encountered in neurosurgical practice. Surgical drainage of this type of hematoma has been used for many years with good results. Nevertheless, with chronic subdural hematomas draining, unexpected neurological complications may occasionally happen. An intracerebral or intraventric...

Acute kidney injury (AKI) due to perioperative rhabdomyolysis is a rare but severe complication that can occur during prolonged surgical procedures, especially in patients with predisposing factors such as obesity, diabetes, and metabolic disorders. This case report describes a 40-year-old woman with a history of non-insulin-dependent diabetes and...

Postoperative (pressure) alopecia (PPA) is a very rare complication, well known by cardiologic surgeons and plasticiens. PPA localized in head rest fixation pointes is exceptionally reported by neurosurgeons. To report a case of PPA localized at head rest fixation pointes. A 50-year-old man presented a PPA occipital localized head rest fixation poi...

Authors describe an intradiploic epidermoid cyst of the parietal bone with intra and extracranial extension. A 23-years old male patient with a history of subcutaneous swelling 3 months ago on the right parietal scalp. CT and MRI evaluation revealed a well defined extracerebral mass in the parietal scalp with destruction of both the inner and outer...

Sciatic peripheral neuropathy or sciatic neuropathy is the overarching condition describing the damage, dysfunction, and pathologic changes of the sciatic nerve trunk along its complete course from the deep gluteal region to the popliteal fossa.

Detailed patient history and careful clinical examination remain important in accurately diagnosing sciatic pain. This clinical assessment (including medical interview, neurologic, spinal, lower limbs, and even general examination) takes considerable time (between 30 and 45 min), and treating clinicians do not have enough with their patients. This...

Common peroneal nerve entrapment (CPNE) occurs because of the compression of this nerve, typically at the fibular tunnel where the nerve is most vulnerable. Due to its superficial nature, the common peroneal nerve can be easily damaged by various etiologies involving the nerve in the fibular head region. This condition may occur in both acute and c...

There are varying extrapelvic tumors associated with sciatic pain. These neoplasms may be originating from local or neighboring musculoskeletal or soft tissue structures along the course of the sciatic nerve (c.f. Chap. 101). Intrinsic tumors growing within the sciatic nerve constitute a specific group of neoplasms-inducing sciatica largely dominat...

The classic definition of the double crush syndrome (DCS) describes a clinical entity of two (or rarely more) sites of compression along a single peripheral nerve. It was first described in 1973 by two Canadian neurologists Adrian Upton and Alan McComas, who postulated that a proximal lesion in a nerve would make that same nerve more vulnerable to...

A conjoined nerve root (CNR) is a type of developmental/embryological anomaly involving two adjacent nerve roots which share a common root sleeve at some part during their running course from the dural sac. The concerning neural exit foramina may be empty or sometimes contain two nerve roots instead of one. Sometimes, there is also an abnormal anas...

The conus medullaris or “conus terminalis” is the terminal end of the spinal cord, which typically occurs at the L1 vertebral level in the adult that corresponds to the sacral cord segment between S1 and S5. The lower end of the conus medullaris is called “epiconus”. After the spinal cord ends caudally, the spinal nerves continue to branch out diag...

The foraminal zone is the limited area between planes passing through the medial and lateral borders of the pedicles. While the extraforaminal zone is the area outside the sagittal plane of the lateral borders of the pedicles, the extraforaminal zone has no precise lateral border but is certainly posterior to anterior zone (AKA anterior retroperito...

The sciatic nerve (AKA ischiadic nerve, ischiatic nerve, or nervus ischiadicus in Latin), about the thickness of a finger, is the largest and longest nerve in the human body. It has a long course right from its origin in the lumbosacral spinal canal to its division in the apex of the popliteal fossa. It is a mixed nerve having both motor and sensor...

Spinal pathologic fractures (SPF) occur in the setting of pathologic weakening of the vertebra secondary to an underlying disease. This condition is also called “secondary spinal fracture,” “spontaneous spinal fracture,” or “vertebral compression fracture.” These fractures are unique in that they are usually non-traumatic in nature. Most SPF concer...

Penetrating spine injuries involves a wound in which an object breaches the spinal column with or without an exit wound. The majority of these injuries are serious medical emergencies and may cause permanent disability or death. The management of these injured patients is completely different from other traditional forms of spinal traumatic injurie...

A spinal subdural hygroma is a collection of cerebrospinal fluid (CSF) trapped in the subdural space between the spinal arachnoid mater and the spinal dura mater. Some spinal hygromas can be extradural, but this is a very rare condition. Spinal hygromas are encountered in all age groups from children to aging adults.

A number of pregnant women will suffer from mild pain in the sciatic nerve, particularly in the second and third trimesters of pregnancy, as the fetus progressively grows more. This sciatic pain was unrelated to a compressive lumbar disc herniation (c.f. Chap. 25 about Pregnant Women with Lumbar Disc Herniations).

From “Sciatica of Atlas” to “Atlas of Sciatica.”

Spondylolysis refers to a defect in the pars interarticularis (aka isthmus) of the neural vertebral arch between the superior and inferior articular facets of the same vertebra. The term is from the Greek words spondylos (vertebra) and lysis (defect). Spondylolysis can be unilateral or bilateral and most cases occur in the lower lumbar vertebrae. B...

Among the abdominopelvic causes of sciatic pain, vascular lesions are sometimes developing diagnostic confusion with the traditional spinal causes. However, neurologic symptoms are mostly poorly defined and cannot be explained by a single nerve or single root lesion. Indeed, most patients present with a lumbosacral radiculoplexus neuropathy (includ...

Arachnoid cysts, also known as “leptomeningeal cysts”, are nonneoplastic cerebrospinal fluid (CSF)-filled sacs lined with the arachnoid membrane composed of arachnoidal cells and collagen. The arachnoid membrane is one of the three meninges that envelop the spinal cord and the spinal nerve roots. Arachnoid cysts can be primary (congenital) or secon...

The pain generated from the sacroiliac joint results in postero-superior iliac and back pain. Pain can also spread to the abdominal and groin area, leg, and even foot. About a third of patients with sacroiliac disorders have leg pain. Some cases may present symptoms similar to those of sciatic nerve impairment (Figs. 92.1, 92.2, 92.3, 92.4, 92.5, 9...

The word “sciatica” is associated with the “sciatic nerve,” which is related to the anatomic region of the hip. The name “hip” refers to “ischia/ischiaticus” in Latin. The suffix “ica” indicates a disability of the “ischia.” With time, the vowel “i” was deleted in the everyday language so that only the word “sciatica” remains. “Ischia” derives also...

The classic definition of double crush syndrome (DCS) describes a clinical entity of two (or rarely more) sites of compression along a single peripheral nerve. Concomitant compressive causes coexist and synergistically increase neurological symptom intensity. Furthermore, the poor result obtained after treatment at one site may be the consequence o...

Sciatic radicular pain can be the consequence of “decompression sickness” (DS): a condition that results when quick decompression causes nitrogen (less often helium) bubbles to form in the tissues of the body. This complication occurs mainly from underwater diving decompression (Fig. 108.1). Other conditions may be encountered, such as flying in an...

Migrated disk fragment is a form of extruded disk herniation (AKA disk extrusion) in which a portion of disk material is displaced away from the site of extrusion in either the sagittal or axial plane.

Sciatica, whether acute or chronic, is among the top most common pain in humans with considerable medical and economic implications. Many people currently use the Internet and consult “Doctor Google” to obtain medical information about their conditions. Concerning sciatica, this term is in the top 20 search pain queries in the world, especially in...

Phantom limb pain (PLP) is a well-known consequence following the amputation of the upper or lower limb, occurring in up to 80% of amputee patients. This condition was first described in 1552 by the French surgeon Ambroise Paré (1510–1590) who clearly differentiated between PLP, phantom sensation, and stump pain (Table 110.1). The American physicia...

A spinal subarachnoid hematoma is a collection of blood in the intraspinal subarachnoid space that lies between the pia mater and the arachnoid and is filled with cerebrospinal fluid (CSF) that envelops the brain, the spinal cord, and the spinal nerve roots. While most intraspinal hematomas occurred at the level of thoraco-lumbar and cervico-thorac...

Most cases of sciatic radicular pain have a spinal origin. However, sciatica can be the main presenting symptom in some patients with intracranial lesions. For some authors, this pain is a true “sciatica,” while for others it is only referred to pain known as “sciatica-like leg pain.” Whatever the designation, this is a false localizing presentatio...

Ganglion and synovial cysts are nonneoplastic synovial or gelatinous cystic lesions that originate within the soft tissue near a joint. These cysts may be unilocular or multilocular mostly located in the periarticular regions of the wrists, knees, and feet. Ganglion and synovial cysts are similar clinically and in imaging appearance. Sometimes, the...

Therapeutic possibilities for symptomatic lumbar disk herniation (LDH) include both conservative and surgical treatment. Most patients benefit from conservative treatment; however, surgery is recommended in some conditions especially when cauda equine syndrome (CES), motor weakness, or pain refractory to conservative treatment exists. The radicular...

Extrapelvic hematomas causing sciatic pain represent a rare, heterogeneous group of pathologies that are occasionally confused with the traditional spinal causes of sciatica. However, most patients with this condition present with sciatic peripheral mononeuropathy, much more than an isolated L5/S1 radiculopathy or pure lumbosacral neuropathy.

A stress fracture is an overuse bone injury secondary to a mismatch of bone strength and chronic mechanical stress placed upon the bone. This condition is usually seen in the lower extremities and less often in the upper extremities. The pelvis and sacrum are unusually involved.

Tarlov cysts, also known as spinal “perineural cysts”, are cerebrospinal fluid-filled dilatations of the nerve root sleeve at the posterior root ganglion usually found in the lower lumbar spine and the sacrum (Figs. 64.1, 64.2, and 64.3). These cystic lesions may be solitary or multiple and correspond to type II of Nabors’s classification of spinal...

Nerve roots extradural fibrous entrapment is a rare pathologic entity defined by circumferential fibrous adhesion of intraspinal extradural nerve roots with subsequent constriction and entrapment but without remarkable neuroimaging findings.

Among the intraspinal causes of sciatic pain, vascular lesions are sometimes developing diagnostic confusion with the traditional degenerative etiologies. However, lumbosacral radicular symptoms are frequently poorly defined and rarely isolated. These vascular lesions are variable and can be intradural or extradural. Depending on their origin (arte...

Dural ectasia, also recognized as an “enlarged dural sac”, refers to the ballooning or widening of the dural sac. This rare entity may be associated with herniation of spinal nerve root sleeves out of adjacent neural foramina, scalloping of the posterior vertebral body, bony erosion of pedicles and lamina, and widening of nerve root foramina. The l...

Rheumatoid arthritis (RA) is a long-term autoimmune inflammatory disorder that primarily affects peripheral joints such as those in the hands, knees, hips, and feet. This disease mainly leads to erosion and joint damage. Spinal involvement is uncommon in RA and had a predilection for the cervical level. Some patients may present low back pain and s...

Arachnoiditis ossificans is a rare pathologic entity defined by calcification or ossification of the spinal arachnoid layer. The lesion is typically limited to the spinal thoracic regions (2/3 of cases) and less frequently in the lumbar spine (1/4 of cases).

Posterior ring apophysis separation (PRAS) is an unusual pathological entity characterized by the separation of a bony fragment at the posterior superior or inferior endplates of the vertebral body in the weak junction between ring apophysis and the adjacent vertebral body (the site of attachment of the Sharpey fibers of the intervertebral disk) (F...

Epidural migration of a herniated intervertebral disk into the posterior space is a rare phenomenon with about 120 cases documented in the literature since the first description by Dandy in 1942 and Lombardi in 1973. The majority of posterior epidural migration of lumbar intervertebral disk fragments (PEMLIFs) is located in the lumbosacral spine, m...

Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder characterized by villous and nodular overgrowths of the synovial joints of either a tendon sheath or a joint. Most cases are monoarticular which interest peripheral joints of the lower extremities. It is a well-recognized entity that has the potential for focal destruction. Sc...

Spinal epidural lipomatosis is the result of abnormal accumulation of unencapsulated fat tissue within the epidural space of the spinal canal. This unusual disease may be asymptomatic while other severe forms impinge on the thecal sac in the lumbosacral area or cause spinal cord compression in the cervicothoracic region. The lumbar region is by far...

Pediatric (children and adolescents) lumbar disk herniations (LDHs) are relatively rare representing less than 5% of all LDHs. For many authors, pediatric forms of LDH are distinct from those occurring in adults due to some different clinical–pathological features.

Adequate management of sciatica needs to include enough listening to patients’ stories, offering an adequate physical assessment, ample information about their complaints, and timely accurate diagnosis of the disorder. Explaining the choice of the type of treatment, its efficacy, complications, and limits are seen as positively contributing to the...

Intradural lumbosacral tumors (IDLSTum) may arise from the nerve roots, the leptomeninges, or the filum terminale (Fig. 42.1). The 20 lumbo-sacro-coccygial nerve roots constitute the cauda equina (horse tail) that originates from the conus medullaris (the terminal end of the spinal cord). The cauda equina nerve roots exit the thecal sac at each lev...

Sciatica occurs when there is pathology anywhere along the course of the sciatic nerve from its origin to its dividing branches. To understand this painful symptom, it is important to consider the differences between the various topographical levels at which lesions can occur. These levels are subdivided into three main categories namely radiculopa...

Surgical treatment for discogenic sciatica may be considered if the patients fail to improve satisfactorily under conservative therapy or when they have red flag symptoms or signs (i.e., progressive neurological deficit, cauda equina syndrome (CES), sphincter disturbances, uncontrolled pain, and even bilateral radiculopathy).

Sometimes lumbar structural scoliosis can cause lumbosacral radicular pain in the lower extremities, especially in adults. These patients may have coronal and sagittal deformities. When this happens, sciatica often results from foraminal stenosis with compression of its corresponding nerve root at the apex of the open end of the scoliosis curve.

There are varying extrapelvic tumors associated with sciatic pain. These neoplasms may be originating from local or neighboring musculoskeletal or soft tissue structures along the course of the sciatic nerve from the sciatic notch to the knee (Table 101.1). Regardless of their cause and their aggressiveness, there are four main types of extrapelvic...

Before treating the pain and offering the best chance for the patient to recover, it is crucial to accomplish an accurate diagnosis and correctly identify the topography and cause of sciatica. However, the medical literature indicates that the reliability of history taking and physical examination in patients suspected of sciatic pain related to lu...

Langerhans cell histiocytosis (LCH), previously known as histiocytosis X, is a rare benign nonneoplastic (tumor-like) disease of the reticuloendothelial system associated with a proliferation of Langerhans cells and comprises three different forms: Letterer-Siwe disease, Hand-Schüller-Christian disease, and Eosinophilic granuloma. Sciatica pain ind...

A wide variety of benign and malignant neoplasms can involve the lower spine and induce low-back pain and lumbosacral radicular symptoms with or without neurological deficits (Fig. 39.1).

A dural tear or “unintended incidental durotomy” is a common and well-known complication following spinal surgery. It occurs in up to 16.7% of spinal operations especially when associated with previous or revised spinal surgery, increasing age, and severe spinal stenosis. Persistent cerebrospinal fluid (CSF) leakage and/or fistulas may result in ps...

Spinal infections may interest the vertebral column (osteomyelitis), the intervertebral disc space (discitis), the spinal canal (epidural, subdural, and spinal cord abscesses), and the adjacent soft tissues (especially pyomyositis). The most common type of spinal infection involves the intervertebral disc space and the adjacent vertebral bodies, kn...

Intraradicular disc herniation is a special type of intradural disc herniation (c.f. Chap. 30) where an intervertebral disc fragment penetrates into the dural root sleeve (Fig. 31.1). This rare entity was first described by Barbera et al. in 1984. Since then, less than 30 cases have been documented to date, exclusively in the lumbar spine. Most pat...

The majority of spinal tumors arise from the vertebral bone. If the tumor continues to grow, it can invade the epidural space, becomes vertebroepidural, and causes neurologic damage. Though more infrequent, some tumors can originate from the epidural space itself (Fig. 40.1). Pure spinal epidural tumors constitute a distinct clinic-pathologic group...

Gout and pseudogout (AKA chondrocalcinosis) are the two main forms of microcrystalline arthropathy that typically affect peripheral joints including the knee, ankle, wrist, hand, and metatarsophalangeal joints. Gouty arthritis results from the deposition of monosodium urate crystals within and around the joints and soft tissues, whereas pseudogouty...

Most intraspinal suppurative collections are contained in the epidural or extradural space between the spinal dura mater and the osseous-ligamentous structures of the spine (Fig. 53.1). Intraspinal infections are less often encountered within the spinal cord parenchyma or the subdural space. “Abscess” is characterized by a capsule that separates th...

Pain is not a pleasant feeling, but it is sometimes a necessary signal for the human body because it draws attention to what is wrong. Concerning sciatica, one of the most common pain complaints in human life, there are myriad medical conditions manifesting clinically as sciatic pain, although lumbar disk herniation (LDH) is its most common etiolog...

A compartment syndrome occurs when pressure within a closed muscle compartment goes beyond the perfusion pressure and results in muscle and nerve ischemia, creating a varying degree of deficit that may be neuropathic, myopathic, or mixed. In the lower limb, the sciatic nerve trunk may be compressed due to limited space and the increased pressure in...

Hematomas of the ligamentum flavum are benign bleeding collections developed within the layers of the ligamentum flavum (yellow ligament). Most cases occur in the anterolateral spinal epidural space and may compress the neural elements and result in a neurological disturbance in many patients. In the lumbar region, a significant number of cases wil...

Lumbar spinal stenosis (LSS) refers to a narrowing in the lumbar spinal canal. The reduction in the canal size could be in the spaces of: central canal, lateral recesses, and/or neural foramen. This condition may induce lumbosacral radiculopathy with or without neurological deficits as well as neurogenic claudication. Management of different etiolo...

Spinal synovial cysts are benign cystic lesions attached to the facet joint (also named zygapophyseal joint) and containing clear/straw color fluid lined by a cuboid/pseudostratified membrane (Figs. 79.1 and 79.2). In the spine, these cysts are found ventral to the ligamentum flavum and they are also described in the literature as “ganglion cysts”...

Classically, the term “piriformis syndrome” has been used to define an entrapment neuropathy involving compression of the sciatic nerve by the piriformis (AKA pyramidal) muscle causing buttock pain, sciatic pain, or both. The sciatic nerve has a close relationship to the piriformis muscle, exiting the pelvis frequently below the muscle at the great...

During various times of pregnancy, there is an increasing risk of intervertebral lumbar disk herniation (LDH). The reported incidence of symptomatic LDH during pregnancy is about 1 in 10,000 pregnant women. Two important factors that may rise this incidence in the parturient population are high body mass index and increased age.

Surgical complications are defined as any event deviating from a normal postoperative course or that may require (re)intervention, additional diagnostic assessments, or further monitoring. These complications can be intraoperative, early postoperative, or occurring long-term following the surgical procedure.

The natural history of the disease was defined as the “natural course” of a disease from the time immediately prior to its inception, progressing, through its presymptomatic phase and different clinical stages to the point where it has ended and the patient is either cured, chronically disabled, or dead without external intervention.

A spinal subdural hematoma is a collection of blood in the intraspinal subdural space which is the potential space between the arachnoid mater and the dura mater of the meninges that envelop the spinal cord and the spinal nerve roots. The predominant location was the thoracic spine.

Classically, the term “sciatica” is known to be specific to the pain, and/or paresthesia, which is a direct consequence of sciatic nerve root (L4–S3) or sciatic nerve compression/irritation. Most cases of sciatica result from an inflammatory or a mechanical disorder. Spinal sciatica may result from a variety of degenerative problems dominated by lo...

Heterotopic ossification (HOS) [formerly known as para-osteoarthropathy] is the formation of mature lamellar bone within soft-tissue sites outside the skeleton. Classically, the development of HOS is extra-articular because it occurs outside the joint capsule. There are two types of HOS: nongenetic (most frequent) and genetic (unusual).

Traumatic sciatic nerve mononeuropathy is a rare but severe condition sustained after acute (most frequent), chronic, or complex injuries. Trauma can be closed or open, accidental or iatrogenic. Due to its significant length, the sciatic nerve can be injured in different anatomical regions, from the sciatic notch to the knee. In addition, injuries...

Conservative (nonsurgical) management is typically the first-line therapeutic intervention in the majority of patients with discogenic sciatica as long as they have no red flag symptoms or signs (i.e., progressive neurological deficit, cauda equina syndrome, sphincter disturbances, uncontrolled pain, and even bilateral radiculopathy). Moreover, sci...

Cysts of the ligamentum flavum, also known as “flaval cysts”, are benign fluid collections developed within the layers of the ligamentum flavum (yellow ligament). Most cases grow into the anterolateral spinal epidural space and may compress the neural elements and result in a neurological disturbance in many patients. In the lumbar region, a consid...

Herpes simplex virus (HSV) and varicella-zoster virus (VZV) are both DNA viruses that are closely linked. Initial infection with VZV can cause acute illness (chickenpox), generally in children and young adults. It presents as a highly contagious rash associated with clusters of vesicles on the skin and mucous membranes. Herpes simplex virus infecti...

A discal cyst, also known as a “disk cyst,” is an unusual spinal entity defined as the communication of an intraspinal extradural cyst with the adjacent intervertebral disk. First described in the English literature by Kono et al. in 1999, approximately 130 cases have been identified to date, exclusively in the lumbar spine. For some authors, disca...

Unlike extraforaminal lumbar disk herniation (LDH) (c.f. Chap. 17), anterior retroperitoneal LDH (ARLDH) represents a disk fragment migrating too anteriorly in the retroperitoneal space, sometimes far away from the original intervertebral disk space (Figs. 23.1 and 23.2). Accordingly, some authors improperly use the term “extreme lateral” or “far l...

Diffuse idiopathic skeletal hyperostosis (DISH) (AKA Forestier’s disease) is a noninflammatory entity characterized by bony proliferation (hyperostosis) at sites of tendinous and ligamentous insertion surrounding the spinal joints. This phenomenon occurs in the absence of degenerative, traumatic, or infectious abnormalities. The majority of lesions...

Ossification of the posterior longitudinal ligament (OPLL) is an uncommon pathologic entity characterized by heterotopic ossification of the posterior longitudinal ligament, as the appellation suggests. It may induce spinal canal stenosis with subsequent development of myelopathy and/or radiculopathy due to direct neurologic compression, ischemia,...

Spondylolisthesis refers to a slippage (displacement) of one vertebral body compared to another. Overall, this displacement could be anterior (anterolisthesis) or posterior (retrolisthesis) with respect to the inferior adjacent vertebral body. However, in practice, the term “spondylolisthesis” is used to design an “anterolisthesis.” Lateral displac...

Pelvic and intrapelvic infections may involve various anatomic structures including bones, joints, muscles, intrapelvic organs, vessels, and nerves (Table 89.1). Sometimes, these infectious lesions may cause sciatic pain, which is difficult to distinguish from traditional spinal sciatica. However, most patients with sciatica related to pelvic and i...

Common lumbar disk herniations (LDH) (namely central and subarticular ones) may be confused with many spinal and intraspinal lumbosacral lesions that differ by their origins and locations. However, the majority of these “pseudo-disk herniations” are extradural intraspinal masses ventral to the thecal sac. In the case of diagnostic ambiguity or atyp...

Sciatic neuropathy due to external nerve pressure is a rare but severe complication following prolonged immobilization and incorrect positioning. This condition can be unilateral or bilateral.

De Anquin’s disease (DAS), also known as “spinous engagement syndrome”, “engaged spina bifida”, or “clasp-knife deformity”, is a rare congenital anomaly found at the posterior lumbosacral spine.

Massive lumbar disk herniation (LDH) is an unusual condition defined as herniated disk occupying more than 50% of the antero-posterior diameter of the lumbar spinal canal (Figs. 20.1 and 20.2). Also recognized as “giant” or “large” disk herniation, they represent 8–22% of all LDHs. The majority of these lesions involve low lumbar intervertebral lev...

Gas formation within the intraspinal epidural space is an uncommon phenomenon mainly seen secondary to lumbar puncture, epidural anesthesia, spinal surgery, trauma, neoplasm, or epidural infection. More rarely, epidural gas can be related to degenerative disc disease due to a “vacuum phenomenon” (intradiscal gas) as a result of spine movement, espe...

Generally, the term “sciatica” is known to be specific to the pain, and/or paresthesia, which is a direct consequence of sciatic nerve root (L4 to S3), lumbosacral plexus, or sciatic nerve irritation. Most cases of sciatica result from mechanical compression and inflammatory disorders. Spinal sciatica may result from a variety of degenerative probl...

Sciatic pain can be the consequence of iatrogenic injury to the sciatic nerve resulting from a misplaced gluteal intramuscular injection (GIMIJ). The sciatic nerve is the most usually injured nerve following intramuscular injection because of its large size and the fact that the buttock is a common injection site. This iatrogenic complication leads...

Paget’s disease of the bone (AKA osteitis deformans) is a chronic skeletal growth disorder characterized by excessive abnormal bone remodeling. The etiology is not entirely known, but it is a disease of osteoclasts. Both genetic and acquired factors (mainly viral agents) have been suggested to be involved. The affected bone (one or multiple) is les...

Lumbar adhesive arachnoiditis is a rare pathologic condition defined as an inflammation of the arachnoid layer and the arachnoid space leading to scar formation between the intrathecal rootlets and resulting in compression of the cauda equina nerve roots (Fig. 55.1).

Axial spondyloarthritis is a chronic auto-inflammatory rheumatic disease predominantly affecting the axial skeleton (mainly sacroiliac joints and spine) with a variable clinical presentation. The most common subtype of the axial spondyloarthritis disease group is ankylosing spondylitis (AKSP), also known as Marie-Strümpell disease or Bechterew dise...

Baastrup disease, also known as “kissing spines syndrome”, is a common but misdiagnosed clinical and radiological disorder of the lumbar spinal column first described in 1933 by the Danish radiologist Christian Ingerslev Baastrup (1885–1950).