This chapter, the orthopedic experts of Kunming Kunlu Orthopedics Hospital introduce diseases that are easily confused with lumbar disc herniation in clinical practice.
Diseases That Are Easily Confused with Lumbar Disc Herniation
1. Lumbar Spinal Stenosis: Nearly half of the cases of lumbar disc herniation and bulging coexist with spinal stenosis. Intermittent claudication is the most prominent symptom of lumbar spinal stenosis. After walking a certain distance, the lower limbs may feel sore, numb, and weak. Resting by squatting allows continued walking. Cycling and lying down usually cause no symptoms. The affected limb's sensation, movement, and reflexes often show no abnormal signs, primarily judged clinically. CT scans are very helpful for diagnosis.
2. Tuberculosis of the Lumbar Vertebrae: Patients with tuberculosis of the lumbar vertebrae generally only experience back pain, rarely showing nerve root symptoms. However, when bone destruction, vertebral body collapse, and cold abscesses exert pressure, neurological symptoms may occur. Patients with tuberculosis of the lumbar vertebrae often exhibit systemic symptoms such as low-grade fever, night sweats, weight loss, anemia, and increased erythrocyte sedimentation rate. X-ray shows bone destruction of the vertebral body, formation of sequestra, narrowing of the intervertebral space, and paravertebral abscesses. CT scans have higher diagnostic value.
3. Spinal Tumors: Back pain caused by spinal tumors is mostly persistent and progressively worsening, more evident at night, and not relieved by lying down. Pain from lumbar disc herniation or bulging is generally intermittent, and resting in bed can alleviate the symptoms. Imaging of spinal tumors can reveal bone destruction.
4. Intradural Tumors: These can cause nerve root symptoms, possibly compressing the cauda equina and leading to cauda equina syndrome. However, intradural tumors in the lumbar spine have the following characteristics: continuous back pain, especially noticeable at night, confirmed by MRI which verifies the presence of intradural tumors.
5. Strain: Chronic strain in the waist often follows incomplete recovery after acute lumbar sprains or is caused by long-term poor working posture and overwork. It may radiate to the buttocks or posterior thigh, but the symptoms and signs do not affect the lower leg and foot. There are no changes in muscle strength, sensation, or reflexes. A CT scan may be necessary when differential diagnosis is difficult.
6. Spondylolisthesis: Common causes include pars fractures and degeneration. Clinically, it is characterized by intermittent claudication. Imaging studies can clearly differentiate it.
7. Piriformis Syndrome: Patients with piriformis syndrome may present with a positive Tinel sign on the buttock pressure point. Passive hip flexion, adduction, and internal rotation increase pain. During the "4" word test, external force opposition can exacerbate or induce sciatica. Patients with lumbar disc herniation or bulging show negative results in these tests. Imaging studies can clearly differentiate between the two.
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Kunming Kunlu Hospital Orthopedic Experts remind: Pay attention to various signals sent by your body and adjust accordingly. Understanding disease symptoms can effectively prevent and treat the occurrence of diseases. If you have any questions, you can consult online experts. Wishing you a speedy recovery.
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