Selective computed tomography-guided perisciatic injection as a diagnostic tool in multiple hereditary exostoses

Area of Science:

• Orthopedics
• Radiology
• Pain Management

Background:

• Multiple hereditary exostoses (MHE), an autosomal-dominant condition, causes osteochondromas that can lead to significant complications.
• Patients with MHE may experience sciatic pain due to neural compression from osteochondromas, posing diagnostic challenges.

Observation:

• A patient with MHE presented with severe sciatic pain and functional impairment, initially considered for revision spine surgery.
• Computed tomography (CT)-guided perisciatic nerve injection was used to differentiate spinal stenosis from peripheral nerve compression by a pelvic osteochondroma.

Findings:

• The CT-guided injection provided immediate, substantial relief, indicating the pelvic osteochondroma as the source of sciatic pain.
• Subsequent excision of the proximal femur osteochondroma successfully resolved the patient's sciatic pain and functional limitations.

Implications:

• CT-guided perisciatic nerve injection is a valuable tool for diagnosing sciatic pain in MHE patients with multiple potential compression sites.
• Accurate diagnosis through targeted nerve blocks facilitates appropriate surgical management and improves patient outcomes in complex MHE cases.