Causas de ciatica

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Acetabular Paralabral Cyst as a Rare Cause of Sciatica. A Case Report
Huw G. Jones, Stephen M. Sarasin, Stephen A. Jones and Peter Mullaney J Bone Joint Surg Am. 2009;91:2696-2699. doi:10.2106/JBJS.H.01318

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BY

T HE J OURNAL

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AND J OINTS URGERY, I NCORPORATED

Acetabular Paralabral Cyst as a Rare Cause of Sciatica
A Case Report
By Huw G. Jones, MBBCh, Stephen M. Sarasin, BSc(Hons), MSc(Orth)Eng, MBChB, MRCS, FRCS(Orth), Stephen A. Jones, BSc(Hons), MSc, MBBCh, MRCS, FRCS(Orth), and Peter Mullaney, BMedSci, BMBS, MRCS, FRCR
Investigation performed at the Department of Orthopaedics, Llandough Hospital, Cardiff, United Kingdomo our knowledge, there have been only two reported cases of large acetabular paralabral cysts causing sciatica1,2 and none reported in the English-language orthopaedic surgical literature. Sciatica is defined as pain experienced along the sciatic nerve distribution. It is most commonly caused by a herniated disc or spinal stenosis3. Extraspinal pathology associated with symptoms and signs ofsciatica is infrequent. Synovial cystic lesions are commonly found in large joints, such as the shoulder, knee, and hip. Such lesions, when occurring in the hip and shoulder joints, are often associated with labral tears and are known as labral or paralabral cysts according to their anatomical relationship with the joint1,4. In the hip, tears of the labrum can cause loss of congruity between thefemoral head and the acetabulum, thus leading to increased intra-articular pressure. This elevated pressure can force synovial fluid into the acetabulum or the surrounding soft tissues, causing a paralabral cyst. These cysts can produce joint instability and pain5,6. There have been many reports of juxta-articular cysts causing compression of adjacent neurovascular structures. Glenoid paralabral cystsof the shoulder have been reported to be associated with compression of the axillary and suprascapular nerves7, elbow or wrist ganglia have been associated with radial nerve compression8 or ulnar nerve compression in the cubital tunnel9, and large paralabral cysts, which are much less common than other cysts and occur around the hip joint, have been associated with compression of the vascular andneurological structures, such as the femoral vein and artery10,11 and the sciatic nerve1. In this case report, we present a patient who had a paralabral cyst and associated symptoms and signs of sciatic nerve compression. The patient was informed that data concerning the case would be submitted for publication, and he consented, and approval from the institutional review board was obtained.

TCase Report thirty-eight-year-old man presented to our spinal unit with a four-year history of gradually worsening pain in the lower back, radiation of the pain down both lower limbs, and intermittent paresthesias. These symptoms began following an automobile accident. He was otherwise in good health. After having undergone several years of conservative treatment that included anti-inflammatorymedication and physiotherapy, the patient was referred to the spinal team at our institution. A clinical diagnosis of sciatica was made, and a magnetic resonance imaging scan of the lumbar and sacral spine was acquired. The magnetic resonance imaging scan of the lumbar spine showed a posterior-central prolapse of the disc between L4 and L5, with narrowing of the thecal sac on the left side. The...