History Of Ps

The syndrome was actually known in 15th century Florence, when hospitals were filled with cases of sciatica, a term used by Hippocratres, Galen, and Dioscorides (ischiatica). Ischiatica originally meant haunches or hip and gave its name to the ischial tuberosity (4), the approximate anatomical location of the pain's origin and its imagined cause in that era. Sacroiliac arthritis and tuberculosis of the iliopsoas muscles were the proposed pathogenetic mechanisms.

After the work of Mixter and Barr in 1932 (5), people began to accept spinal and intramedullary pathology as the chief causes of sciatica. Effective surgical techniques combined with improvements in anesthesiology and antibiotics made surgery for spinal conditions much more practical. Imaging studies advanced from tomograms through computed tomography (CT) scans to ever more sophisticated magnetic resonance imaging (MRI), rendering diagnosis within the reach of any internist or specialist.

It is this foraminal or intramedullary condition that comes to every clinician's mind when he or she is presented with a patient suffering from sciatica. A group of leading physicians and epidemiologists have defined sciatica as "...symptoms and findings considered to be secondary to herniations of a lumbar disc" (6). However, sciatica is a symptom, not a diagnosis. It describes pain and feelings in the distribution of a peripheral nerve. It stands to reason that pain along the course of the sciatic nerve would at times be caused by pathological involvement of the nerve itself, and that rational diagnosis and treatment would then focus on the site of the pathology.

From: Therapeutic Uses of Botulinum Toxin Edited by: G. Cooper © Humana Press Inc., Totowa, NJ

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