Pediatric sciatic neuropathy: clinical presentation and long term follow up

Abstract

Sciatic neuropathy is rare and difficult to diagnose in pediatrics, and its long-term course has not been completely understood.

Objective: To analyze the clinical presentation and evolution of a group of pediatric patients with sciatic neuropathy.

Patients and Method: Retrospective analysis of the clinical characteristics of pediatric patients with sciatic neuropathy treated in two hospitals of Santiago between 2014 and 2018. Locomotor examination, muscle trophism, deep tendon reflexes, gait, sensation, and pain were assessed. Sciatic nerve conduction study and electromyography (EMG) were performed, and magnetic resonance imaging (MRI) in three patients.

Results: Six patients were included with an average age of 11.8 years. The etiologies were traumatic (N = 2), by compression (N = 2), vascular (N = 1), and tumor (N = 1). All of the 6 patients presented foot drop and Achilles tendon hyporeflexia/areflexia, and 5 patients presented severe neuropathic pain. The EMG showed involvement of the sciatic nerve rami and dependent muscles. In two patients, a pelvic girdle and lower limbs MRI was performed, showing selective muscle involvement in sciatic territory. One patient
underwent a lumbosacral plexus MRI, and subsequently histological study showing a benign
neural tumor. Out of the three patients who were followed-up longer than one year presented motor sequelae and gait disorder.

Conclusion: Sciatic neuropathy in the study group was secondary to different causes, predominantly traumatic and compressive etiologies. The three patients that were in
a long-term follow-up presented significant motor sequelae. In most of the cases, neural injury was associated with preventable causes, such as accidents and positioning in unconscious children, which is crucial in the prevention of a pathology with a high sequelae degree.