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The pseudocrural and pseudosciatic syndromes are clinical syndromes which cause pain in the lower limbs, involving the same areas of the lumbar dermatomes but not the lumbar nerve roots. Although pseudoradicular syndromes may be caused by a variety of diseases, many of these are quite rare. In this review the benign causes of pseudoradicula syndromes (namely, those that are more common but less serious since they are curable) are examined. These syndromes can appear alone, coexist with a compressive nerve root syndrome or else arise following the removal of the nucleus pulposus (by chemonucleolysis, Onik's percutaneous discectomy by aspiration or conventional open discectomy). The clinical differences between radicular syndromes and pseudoradicular syndromes are examined and these forms are subdivided into two main groups on the basis of their underlying mechanisms: pseudoradicular syndromes due to reflex mechanisms (zygapophyseal joint syndrome, iliolumbar syndrome, hip joint pathology) and pseudoradicular syndromes due to a pathology of an anatomical structure of the lower limb (fibromyalgia, myofascial pain syndromes, tendinopathies of the lower limbs, fascia lata and iliotibial band pathology, piriformis syndrome, ischiatic tuberosity fracture, peripheral nerve entrapment). Finding the cause of radicular pain is by no means an easy task, and no physician can admit to never having made a mistake. Although the latest imaging techniques and close collaboration among clinicians, neuroradiologists and neurosurgeons can do much to reduce the margin of error, it is all but impossible to eliminate it entirely.
Key words: Pseudoradicular syndromes.
Pseudocrural and pseudosciatic syndromes are clinical syndromes which cause pain in the lower limbs, involving the same areas of the lumbar (L4, L5 and S1) dermatomes, with no involvement of the lumbar nerve roots 1-3 (Fig. 1).
Pseudoradicular syndromes can be caused by a variety of diseases (ankylosing spondilitis, pyogenic or rheumatic sacroiliitis, osteitis condensans ilii, polymyalgia rheumatica, herpes zoster, tumors and infiltrative lesions of the pelvis, diabetic neuropathy and so on), many of which are quite uncommon.
In this review we will examine the common causes of pseudoradicular syndromes; namely, the most frequent and benign causes.
The differences between radicular syndromes and pseudoradicular syndromes are illustrated in Table I.
These syndromes can appear alone, coexist with a compressive nerve root syndrome or else arise after removal of the nucleus pulposus (by...