Sciatic Tension Signs and Lumbar Disc Herniation

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Abstract
Sciatic stretch maneuvers designed to elicit signs of nerve root compressions secondary to lumbar disc herniation were evaluated in a prospective manner to correlate intraoperative evaluation of surgical pathology regarding level and anatomic location and proximity of the herniated disc to the nerve root. To study the correlation between specific diagnostic maneuvers of sciatic stretch and anatomic location or level of lumbar disc pathology. Maneuvers of sciatic tension, such as the straight leg lift, the well leg lift, Lasègue's sign, and the bowstring sign, have been used since the 1880s as a diagnostic maneuver to separate sciatica from hip pain. Fifty consecutive candidates with clinical and radiographic evidence of disc herniation were examined. Initial physical examination included evaluation of sciatic tension signs using the straight leg lift, cross leg lift, Lasègue's sign, and the bowstring sign. The presence of lumbar disc herniation was confirmed radiographically. Intraoperatively, the 50 patients were assessed for anatomic location of disc herniation and the presence of disc protrusion or extrusion. The straight leg lift was the most sensitive preoperative physical diagnostic sign for correlating intraoperative pathology of lumbar disc herniation. Physical diagnostic maneuvers for evaluating sciatic tension in patients with documented lumbar disc herniation have a high correlation with surgical pathology. These diagnostic signs of sciatic stretch can be reliable guides that lead to more aggressive modes of evaluation. No correlation was found between specific sciatic stretch maneuvers regarding location of disc herniation relative to the nerve root.

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