Journal of Neurosurgery: Spine

Feb 2011 / Vol. 14 / No. 2 / Pages 281-289

Article

Cyclic sciatica from extrapelvic endometriosis affecting the sciatic nerve
Case report

1Departments of Neurosurgery, 2Gynecological Oncology, and 3Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Abbreviations used in this paper: EMG = electromyography; GnRH = gonadotropin-releasing hormone.
Address correspondence to: Ian E. McCutcheon, M.D., Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 442, Houston, Texas 77030. email: .

Please include this information when citing this paper: published online December 24, 2010; DOI: 10.3171/2010.10.SPINE09162.

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By Keywords:
endometriosis, sciatic nerve, catamenial, sciatic notch

Abstract

Sciatic (catamenial) radiculopathy, waxing and waning with the menstrual cycle, is an uncommon condition typically caused by pelvic endometriosis affecting the lumbosacral plexus or proximal sciatic nerve. The authors describe a woman with catamenial sciatica caused by endometriosis affecting the sciatic nerve trunk in the upper thigh. Symptomatic with leg pain for 5 years, this patient developed gluteal atrophy and sensory loss and decreased strength in the L-5 dermatomyotome, a distribution confirmed by electromyography. Magnetic resonance imaging suggested thickening of the sciatic nerve at and distal to the sciatic notch. At operation the nerve showed extrinsic and intrinsic abnormality, proven to be endometriosis. Her symptoms improved, and she began gonadotropin-releasing hormone agonist therapy for further suppression. This very unusual case shows that endometriosis can affect the sciatic nerve over a range of territory inside and outside the pelvis, and that surgery must be appropriately directed to avoid negative exploration. Surgical decompression achieves good relief of symptoms, and medical therapy also allows sustained suppression of this disease.

Cited by

  1. Laura Ghezzi, Andrea Arighi, Anna M. Pietroboni, Francesca Jacini, Giorgio G. Fumagalli, Andrea Esposito, Nereo Bresolin, Daniela Galimberti, Elio Scarpini. (2012) Sciatic endometriosis presenting as periodic (catamenial) sciatic radiculopathy. Journal of Neurology. Online publication date: 4-Jan-2012. [CrossRef]
  2. Marina Tommaso. (2011) Pain Perception during Menstrual Cycle. Current Pain and Headache Reports. Online publication date: 10-May-2011. [CrossRef]