Pseudo-Sciatica Due to Pelvic Tumor. Case Presentation

Lumbo-sciatic pain is a symptom caused by a wide variety of processes that can be degenerative, inflammatory, infectious or tumor in nature. We present a patient with confusing clinical characteristics where the delay in diagnosis produces serious conse-quences. The presence of alarm signs, which can translate systemic diseases, and the need to start a study protocol on the subject are discussed.


Introduction
Lumbo-sciatic pain is a symptom caused by a wide variety of processes that can be degenerative, inflammatory, infectious or tumor in nature. Low back pain is a very common presenting symptom in the primary care clinic. Between 70 and 80% of the world's adult population has had an episode of low back pain at least once in their life, of these only 10-12% will have concomitant sciatica [1,2]. This pain syndrome is among the first causes of physical limitation in individuals under 45 years of age [1,3,4] although sciatica will rarely be found in patients under 20 years of age, since the predominant age at which it is suffered is around 40 years [5]. Pseudo-sciatica is a term diagnosis sometimes used to describe sciatic nerve symptoms that are not due to typical spinal sources [1].
Depending on the etiology, low back pain can be classified as nonspecific or specific. If there is a known reason, this will be considered specific, which comprise around 20%, the main causes being herniated discs or osteoporotic fractures, and 5% due to a serious problem such as tumor processes or aortic aneurysm. On [6]. Low back pain is not a diagnosis, it is a symptom that describes the presence of pain in the lumbar vertebral or paravertebral region without referring to the structures causing the process. The poor anatomical and clinical correlation of patients with low back pain is known [7]. Tumor lesions are frequent; in the diagnosis of SOMA lesions, confusing them due to their clinical presentation is also frequent, which complicates early diagnosis and therefore the correct therapy. This presentation is intended to address a rare case interpreted as sacrumlumbosciatica at first and later diagnosed as a pelvic tumor.

Discussion
Low back pain is a very frequent syndrome in the general population, which occurs in approximately 9.4% of the global population, it is a common condition, which nevertheless requires interdisciplinary and complex management. When combined with abdominal-pelvic pain, it is a complex entity, sometimes difficult to diagnose, which requires a thorough analysis to determine its causes and the most appropriate treatment. It involves various viscera, so frequently the approach must be multidisciplinary and sometimes requires rapid action since the life of the patient is at stake [6]. The presence of warning signs can translate into systemic diseases and the need to start a study protocol. Among them the following: [7] Age from 20 years to over 50 years. The bony pelvis is one of the places in the skeleton where we can most frequently find tumor lesions. However, these lesions usually come from tumors of visceral origin (carcinoma metastases) or blood (leukemias, lymphomas, myelomas). Infiltration of the bony wall of the pelvis by visceral tumors located in the pelvic cavity is also relatively frequent. When a mass is located in a limb, it is more easily detectable than when it is located in the pelvis. The tumor in the pelvis has more "room" to grow without being noticed by the patient. The clinical picture is often superimposable with that of lumbar degenerative pathology, which is one of the most frequent reasons for consultation for the orthopedic surgeon [9].
In the case presented, the presence of the primary tumor could not be identified, as the patient died earlier to locate it and it was not possible to perform an autopsy due to the family's refusal.
Bone metastases represent the most common type of malignant bone tumor. The incidence varies depending on the means used for diagnosis. Thus, when we use clinical and radiological data, 15% of patients with carcinoma present with bone metastases, a figure that increases to 30% if the data come from autopsies.
The vertebral column, especially the dorso-lumbar and sacral spine, the pelvic bones, are the most common locations for bone