There was significant difference (p<0.05) in longitudinal and transversal nerve excursion between the healthy and spinally referred leg pain groups.
On ultrasound,
sciatic nerve was visualized as a hyperechoic,
slightly flattened oval structure (Figure 1,
2,
3 and 4).
In first group of healthy persons (18) stiffness of sciatic nerve had lower values of strain index (SI) looking to symptomatic leg pain group (12).
(Fig.11,12,13,14,15,16,17,18,19,20).
In further development in effort to stadardize method,
in healthy group of 42 persons it was shown that the differencies beetwen muscle`s structure and nerv are more compresed dependent,
than the differences of intraneural siffness,
esspecally looking to morfological changes of nervs and of surronding fibrous processes.
The referent value of sciatic nerv in leg extension of asymptomatic varied from 0,6 do 2SI,
x+_SD=0,8+_0,7SI,
cut off (x+_2SD) 2,25SI,
and in leg flexion of asymptomatic varied from 1,5 do 7SI,
x+_SD=2,7+_2,3SI,
cut off (x+_2SD) 7,3SI,
unlike symptomatic leg pain group (27) have had increased stiffness values 5,6+_7,9SI (x+_SD) in extension and 9,3+_13,1SI in flexion,
which was presented on color maps (Figure 11,12,13,14,15,16,17,18,19).
The specificity of method in asymptomatic group was 95,2% (Fig.21),
the sensitivity of ultrasound elastography in symptomatic leg pain group was 85,2% (Fig.22),
with accuracy of 91,3% (Fif.23).
The positive predictive value was 79,3%,
while the negative predictive value was 86,9%.
In 13 patients surgical examination was applied and the stiffness of sciatic nerv decreased significantly in extension from (x) from 9,7SI to 2,4SI,
and in flexion from 15,4SI to 3,7SI.
Upon surgical exploration of the sciatic nerve,
a fibrotic tedious scar beneath the piriformis was found and released (Fig.
26). The posterior (Moore) approach accesses the joint taking piriformis muscle where high bifurcation on sciatic nerve and n.
Peroneus over the piriformis muscle and tibialis beneath piriformis muscle was noted.
Adhesions in area of sciatic incisure and hip capsul were seen.
It was done resection from trochanter’s attachment,
as well as separation of joint tendon of m.piriformis and m.obturator internus,
as release of n.peroneus and n.tibialis from fibrous bands and surrounding muscles.
Then palpation check of nerve tightning was done.