Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2021; 9(5): 1168-1174
Published online Feb 16, 2021. doi: 10.12998/wjcc.v9.i5.1168
Obturator nerve impingement caused by an osteophyte in the sacroiliac joint: A case report
Man-Di Cai, Hua-Feng Zhang, Yong-Gang Fan, Xian-Jun Su, Lei Xia
Man-Di Cai, Hua-Feng Zhang, Yong-Gang Fan, Xian-Jun Su, Lei Xia, Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
Man-Di Cai, Lei Xia, Institute of Spinal Deformity, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
Author contributions: Xia L, Zhang HF, and Cai MD were the patient’s orthopedists, reviewed the literature, and contributed to the conception; Cai MD reviewed the literature and contributed to manuscript drafting; Fan YG contributed to manuscript drafting; Su XJ analyzed and interpreted the imaging findings; Xia L, Zhang HF, and Cai MD were responsible for the revision of the manuscript for important intellectual content; and all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Lei Xia, PhD, Chief Doctor, Director, Professor, Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou 450000, Henan Province, China. zdyfyxialei@163.com
Received: October 20, 2020
Peer-review started: October 20, 2020
First decision: November 24, 2020
Revised: November 28, 2020
Accepted: December 11, 2020
Article in press: December 11, 2020
Published online: February 16, 2021
Processing time: 101 Days and 18.8 Hours
Abstract
BACKGROUND

Cases of obturator nerve impingement (ONI) caused by osteophytes resulting from bone hyperplasia on the sacroiliac articular surface have never been reported. This paper presents such a case in a patient in whom severe lower limb pain was caused by osteophyte compression of the sacroiliac joint on the obturator nerve.

CASE SUMMARY

A 65-year-old Asian man presented with severe pain and numbness in his left lower limb, which became aggravated during walking and showed intermittent claudication. The physical examination revealed that the muscle strength of the left lower limb had decreased and that the passive knee flexion test result was positive. Computed tomography (CT) and 3D reconstruction showed a large osteophyte located in the anterior lower part of the left sacroiliac joint. The results of electrophysiological examination showed peripheral neuropathy. A CT-guided obturator nerve block significantly reduced the severity of pain in this patient. According to the above findings, ONI caused by the osteophyte in the sacroiliac joint was diagnosed. This patient underwent an operation to remove the bone spur and symptomatic treatment. After therapy, the patient's pain and numbness were significantly relieved. The last follow-up was performed 6 mo after the operation, and the patient recovered well without other complications, returned to work, and resumed his normal lifestyle.

CONCLUSION

Osteophytes of the sacroiliac joint can cause ONI, which leads to symptoms including severe radiative pain in the lower limb in patients. The diagnosis and differentiation of this disease should attract the attention of clinicians. Surgical excision of osteophytes should be considered when conservative treatment is not effective.

Keywords: Obturator nerve impingement; Osteophyte; Sacroiliac joint; Case report

Core Tip: Obturator nerve impingement is a peripheral neurogenic disease. It has a low incidence, but symptoms such as pain will affect the work and life of patients. Since the nerve runs deep and belongs to the peripheral nerve, the exact diagnosis is challenging. We present a very rare case of severe pain and numbness in the left lower extremity due to obturator nerve compression by an osteophyte of the sacroiliac joint. Our report could help clinicians diagnose and treat this disease better. Meanwhile, it provides a new idea for unexplained lower limb pain.