From the Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan.
Am J Phys Med Rehabil. 2023 Aug 1;102(8):e103-e105. doi: 10.1097/PHM.0000000000002203. Epub 2023 Feb 3.
Spinal and extrapelvic lesions causing sciatic symptoms are well recognized in clinical research and practice. 1-5 We present a 35-yr-old woman with a history of axial back pain and fibromyalgia who presented with episodes of radicular type pain down her legs and associated bilateral tingling in her feet. Medicinal and therapeutic interventions for traditional sciatica etiologies failed to provide relief. Lumbar magnetic resonance imaging showed mild multilevel degenerative changes and partially visualized fibroids, but no other significant spinal pathology was appreciated. Subsequent pelvic magnetic resonance imaging revealed an enlarged retroverted uterus with multiple fibroid lesions. The patient elected for laparoscopic myomectomy, which improved her likelihood of fertility while drastically alleviating her axial spine and lower extremity symptomology. This case reinforces the importance of keeping a broad differential that includes intrapelvic etiologies when traditional workup and treatment for sciatic neuropathy fails. To our knowledge, this is the first reported case of sciatic neuropathy secondary to uterine fibroids treated with the intent of both fertility improvement and pain relief.
脊柱和盆腔外病变引起的坐骨神经症状在临床研究和实践中已得到广泛认识。1-5 我们介绍了一位 35 岁的女性，她有轴向背痛和纤维肌痛病史，表现为腿部神经根痛发作，并伴有双侧足部麻木。针对传统坐骨神经病因的药物和治疗干预未能提供缓解。腰椎磁共振成像显示轻度多水平退行性改变和部分可见的子宫肌瘤，但未发现其他明显的脊柱病理学改变。随后的盆腔磁共振成像显示子宫增大、后倾，伴有多个肌瘤病变。患者选择了腹腔镜子宫肌瘤切除术，这提高了她的生育能力，同时极大地缓解了她的轴向脊柱和下肢症状。该病例强调了在传统的坐骨神经病变检查和治疗失败时，保持广泛鉴别诊断的重要性，包括盆腔内病因。据我们所知，这是首例报道的因子宫肌瘤引起的坐骨神经病变，采用改善生育能力和缓解疼痛的治疗方法。
