scholarly journals The diagnostic pitfalls of lumbar disc herniation---- malignant sciatic nerve tumour: two case reports and literature review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Li Zhao ◽  
Junqiang Wei ◽  
Chenguang Wan ◽  
Shuhong Han ◽  
He Sun
Keyword(s):  
Clinical Practice ◽  
Sciatic Nerve ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lower Limb ◽  
Lumbar Disc ◽  
Clinical Manifestations ◽  
B Cell Lymphoma ◽  
Malignant Tumours ◽  
The Right

Abstract Background Sciatica pain is a typical symptom of lumbar disc herniation (LDH), but some neurogenic and malignant tumours surrounding the sciatic nerve can also cause similar symptoms. These tumours are often misdiagnosed or even mistreated as LDH in clinical practice. Case presentation In our clinical practice, we found two patients with malignant tumours who were misdiagnosed with LDH. One patient complained of pain and numbness in the right lower limb. The primary diagnosis was LDH, and the patient underwent posterior lumbar interbody fusion surgery. After the operation, the symptoms were not alleviated. Then, diffuse large B-cell lymphoma involving the soft tissue and the sciatic nerve was identified. Another patient who manifested with radiating pain in the right lower limb was diagnosed with LDH at Chengde Central Hospital. He received regular conservative treatment for approximately 6 months, but his symptoms were not relieved, and then he was referred to our hospital. A malignant peripheral nerve sheath tumour (MPNST) of the sciatic nerve was diagnosed, and he received cisplatin (DDP) chemohyperthermia. Conclusions Descriptions of tumour lesions involving the sciatic nerve and misdiagnosed as LDH in the literature are rare. In the reported literature, 7 patients were misdiagnosed with LDH, and all patients presented with sciatica. Among them, 4 patients only received surgical treatment, 1 patient only underwent neurolysis, and 2 patients received both surgical and chemotherapy treatment. Their low incidence and similar clinical manifestations to LDH make malignant tumours involving the sciatic nerve easy to misdiagnose. When the clinical symptoms and signs are inconsistent with the imaging findings, we need to be aware of non-discogenic sciatica, including tumours involving the sciatic nerve. Furthermore, tumours that grow near the exit of the sciatic notch may be misdiagnosed because of their deeper location and because they are covered with gluteal muscles. Sometimes sciatica caused by sciatic nerve tumours is only distal, without any radicular distribution. This pain is more severe than that caused by LDH, and this pain is not related to the position of the lumbar spine. Thus, it is beneficial to perform a detailed physical examination of the sciatic nerve to avoid this kind of misdiagnosis.

scholarly journals Sciatic Herpes Zoster Suspected of Lumbar Disc Herniation: An Infrequent Case Report and Literature Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Fei-Long Wei ◽  
Tian Li ◽  
Yang Song ◽  
Lin-Ya Bai ◽  
Yifang Yuan ◽  
...  
Keyword(s):  
Back Pain ◽  
Case Report ◽  
Herpes Zoster ◽  
Literature Review ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lower Limb ◽  
Lumbar Disc ◽  
Lower Limbs ◽  
The Right

Background: The symptoms of sciatic herpes zoster are sometimes difficult to distinguish from sciatica caused by lumbar disc herniation. We describe a case of suspected lumbar disc herniation with sciatic herpes zoster to reduce the rate of misdiagnosis.Case Report: A 55-year old man, male, developed low back pain after carrying heavy items 20 years ago. Characteristics of symptoms: 1. Symptoms were aggravated in the upright lumbar forward flexion position; 2. The VAS (leg) score was 8–9 points and the VSA (lumbar) score was 0 point; 3. It can be relieved when rested in the supine position; 4. It came on intermittently with radiation pain in the right lower limb. There were several attacks every year. One month ago, there was radiating pain in the right lower limb. The pain was from the back of the right hip, behind the thigh, in lateral crural region, to the back of the foot. And Symptoms worsened for 10 days. The VAS score was 8 points. Pain could not be relieved by rest or changing posture. There was no back pain, no lower limbs, weak walking, no claudication and other symptoms. Analgesics and neurotrophic drugs are ineffective. After the application of antiviral drugs, the radiation pain in the right lower extremity was significantly relieved.Conclusion: We describe this case in detail and discuss how to make an authentic diagnosis, with a concomitant literature review.

scholarly journals A rare case of L5-S1 right severe foraminal stenosis and paramedian disc herniation result in foot drop of right lower extremity: A case report

2021 ◽  
Vol 8 (10) ◽  
pp. 623-627
Author(s):  
Ngoc Quyen Nguyen ◽  
Trong Hau Phan
Keyword(s):  
Lower Extremity ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Rare Case ◽  
Lumbar Disc ◽  
Clinical Manifestations ◽  
Foot Drop ◽  
Foraminal Stenosis ◽  
Mri Findings ◽  
The Right

Objective: the authors presented a extremely rare case of severe foraminal stenosis combined with huge lateral lumbar disc herniation  Case presentation: The authors presented a 74 – year old, male with type II chronic diabetes, had severe pain of the dermatomal distribution of L5, S1 nerve roots, and foot-drop of the right lower limb. When we evaluated the patient’s MRI, the huge paramedian disc herniation of the right L5-S1 level was seen and the right L5-S1 laminotomy and discetomy were planned for the treatment of the patient. However, the clinical symptoms were not completely correlated with that MRI findings so that, we re-checked the MRI, particularly at the lumbosacral region, and the right severe foraminal stenosis of L5-S1 level was found. The patient underwent surgery with facetectomy, transforaminal interbody fusion, and pedicle screw fixation. After the operation, the patient has quickly reduced radiating pain of the right lower extremity, although the foot-drop was not improved. Because of the huge lateral lumbar disc herniation impression, that could affect the assessing the patient’s injury correctly, leaded consequences of a missing diagnosis of foraminal stenosis and inadequate surgery method. Conclusion: It is essential to detail examination of the clinical manifestations and thorough assessment of MRI for evaluation of the correlation between the physical examination and MRI findings before making the decision of surgical method.

scholarly journals The relationship of the shear wave elastography findings of patients with unilateral lumbar disc herniation and clinical characteristics

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Qingyuan Wang ◽  
Hao Zhang ◽  
Jinxin Zhang ◽  
Hanqi Zhang ◽  
Hui Zheng
Keyword(s):  
Sciatic Nerve ◽  
Shear Wave ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Clinical Characteristics ◽  
Lumbar Disc ◽  
Shear Wave Elastography ◽  
Control Group ◽  
Symptom Duration ◽  
Foraminal Stenosis

Abstract Background The aim of this study was to find out whether the shear wave elastography (SWE) findings of patients with unilateral lumbar disc herniation (LDH) were related to clinical characteristics. Methods For this purpose, the study group included patients (N = 20; 13 male, 7 female) with complaints of unilateral sciatica, with foraminal stenosis caused by one level of LDH (L4-L5 or L5-S1). An gender-and age-matched control group (N = 27; 16 male, 11 female) was included. All the patients were examined on both the axial and longitudinal planes bilaterally at the same level using a convex array probe (1- 6 MHz, Supersonic Imagine, Aix en Provence, France). Results The sciatic nerve stiffness measured on longitudinal planes of the affected side was significantly higher than unaffected side (p < 0.001) and the control group (P < 0.05). Furthermore, the symptom duration of unilateral LDH is positively correlated with the stiffness the sciatic nerve (r = 0.52, p = 0.019). Conclusion According to these findings, ultrasound imaging can be considered as a useful tool to detect changes in the sciatic nerve due to disc herniation. This technique will have a promising prospect for many patients with unilateral LDH in monitoring stiffness during rehabilitation and before or after surgery.

scholarly journals Dysfunctional muscle activities and co-contraction in the lower-limb of lumbar disc herniation patients during walking

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Wei Wang ◽  
Hui Wei ◽  
Runxiu Shi ◽  
Leitong Lin ◽  
Lechi Zhang ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lower Limb ◽  
Gait Cycle ◽  
Lumbar Disc ◽  
Lower Limbs ◽  
Heel Strike ◽  
Control Group ◽  
Double Support ◽  
Support Phase

AbstractThis study aimed to investigate lower-limb muscle activities in gait phases and co-contraction of one gait cycle in patients with lumbar disc herniation (LDH). This study enrolled 17 LDH patients and 17 sex- and age-matched healthy individuals. Bilateral muscle activities of the rectus femoris (RF), biceps femoris long head (BL), tibialis anterior (TA), and lateral gastrocnemius (LG) during walking were recorded. The gait cycle was divided into four phases by the heel strike and top off according to the kinematics tracks. Root mean square (RMS), mean frequency (MF), and co-contraction of surface electromyography signals were calculated. The LDH patients showed enhanced BL RMS during the single support phase (SS), second double support phase, and swing phase (SW) as well as decreased MF of RF during SS and of TA and LG during SW (p < 0.05). The co-contraction of the TA-LG was increased in LDH patients than in the control group (p < 0.05). Positive correlations were observed between TA-LG co-contraction (affected side, r = 0.557, p = 0.020; contralateral side, r = 0.627, p = 0.007) and the Oswestry disability index scores in LDH patients. LDH patients have increased BL firing rate and insufficient motor unit recruitment in specific phases in the lower limbs during walking. Dysfunction in LDH patients was associated with immoderate intermuscular co-contraction of the TA-LG during walking.

scholarly journals The relationship of the shear wave elastography findings of patients with unilateral lumbar disc herniation and clinical characteristics

2019 ◽  
Author(s):  
qingyuan wang ◽  
jinxin zhang ◽  
hanqi zhang ◽  
hui zheng ◽  
Hao Zhang
Keyword(s):  
Sciatic Nerve ◽  
Shear Wave ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Clinical Characteristics ◽  
Lumbar Disc ◽  
Shear Wave Elastography ◽  
Control Group ◽  
Symptom Duration ◽  
Foraminal Stenosis

Abstract Abstract Background The aim of this study was to find out whether the shear wave elastography (SWE) findings of patients with unilateral lumbar disc herniation (LDH)were related to clinical characteristics . Methods For this purpose,the study group included patients(N=20; 13 male, 7 female) with complaints of unilateral sciatica , with foraminal stenosis caused by one level of LDH (L4-L5 or L5-S1).An gender-and age-matched control group(N=27; 16 male, 11 female) was included.All the patients were examined on both the axial and longitudinal planes bilaterally at the same level using a convex array probe(1- 6MHz,Supersonic Imagine,Aix en Provence,France). Results The sciatic nerve stiffness measured on longitudinal planes of the affected side was significantly higher than unaffected side (p < 0.001)and the control group (P<0.05).Furthermore,the symptom duration of unilateral LDH is positively correlated with the stiffness the sciatic nerve(r=0.52,p=0.019). Conclusion According to these findings, ultrasound imaging can be considered as a useful tool to detect changes in the sciatic nerve due to disc herniation. This technique will have a promising prospect for many patients with unilateral LDH in monitoring stiffness during rehabilitation and before or after surgery. Keywords Ultrasound 、Sciatic nerve、Shear wave elastography、lumbar disc herniation

scholarly journals The relationship of the shear wave elastography findings of patients with unilateral lumbar disc herniation and clinical characteristics

2019 ◽  
Author(s):  
qingyuan wang ◽  
jinxin zhang ◽  
hanqi zhang ◽  
hui zheng ◽  
Hao Zhang
Keyword(s):  
Sciatic Nerve ◽  
Shear Wave ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Clinical Characteristics ◽  
Lumbar Disc ◽  
Shear Wave Elastography ◽  
Control Group ◽  
Symptom Duration ◽  
Foraminal Stenosis

Abstract Abstract Background The aim of this study was to find out whether the shear wave elastography (SWE) findings of patients with unilateral lumbar disc herniation (LDH)were related to clinical characteristics . Methods For this purpose,the study group included patients(N=20; 13 male, 7 female) with complaints of unilateral sciatica , with foraminal stenosis caused by one level of LDH (L4-L5 or L5-S1).An gender-and age-matched control group(N=27; 16 male, 11 female) was included.All the patients were examined on both the axial and longitudinal planes bilaterally at the same level using a convex array probe(1- 6MHz,Supersonic Imagine,Aix en Provence,France). Results The sciatic nerve stiffness measured on longitudinal planes of the affected side was significantly higher than unaffected side (p < 0.001)and the control group (P<0.05).Furthermore,the symptom duration of unilateral LDH is positively correlated with the stiffness the sciatic nerve(r=0.52,p=0.019). Conclusion According to these findings, ultrasound imaging can be considered as a useful tool to detect changes in the sciatic nerve due to disc herniation. This technique will have a promising prospect for many patients with unilateral LDH in monitoring stiffness during rehabilitation and before or after surgery. Keywords Ultrasound 、Sciatic nerve、Shear wave elastography、lumbar disc herniation

Scoliosis Secondary to Lumbar Spine Herniated Nucleus Pulposus in Adolescents: A Case Report

2021 ◽  
pp. 23-24
Author(s):  
Taif Alqahtani ◽  
Faisal Konbaz
Keyword(s):  
Case Report ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Surgical Intervention ◽  
Lumbar Disc ◽  
Lumbar Pain ◽  
Medical Opinion ◽  
History Of ◽  
The Right ◽  
Straight Leg Raise

Introduction: Herniated nucleus pulposus (HNP) is infrequent among children and adolescents. The first case of surgical intervention for disc herniation was reported in a 12-year-old child. Since then, very few cases or series of cases have been published. The reactive scoliosis is frequently associated with lumbar HNPs, a compensatory effort to relieve nerve compression. Moreover, reactive scoliosis secondary to lumbar HNP is typically associated with children and usually resolves with effective management of lumbar HNP. Although the surgical intervention is frequently employed among adults, only 0.5% of discectomies are carried out in children <16 years old.  The current case report is of a 15-year-old girl, with no history of spinal ailment, who presented with a large disc herniation at L4–L5 region, associated with a reactive secondary scoliosis, which was resolved following a successful surgical intervention. Case Report: A 15-year-old female with known case of scoliosis and a history of lower back pain for nine months following a fall while playing football presented at outpatient clinic. She sought medical opinion after two months of persistent pain with radiculopathy to the right side toward big toe. Similarly, there was normal plantar reflex and no clonus or Hoffman sign. There was positive straight leg raise test as well as positive contralateral straight leg raise test. Scoliosis is idiopathic in majority of young patients. However, it might also arise as a part or complication of a triggering health state. Although scoliosis has been frequently associated with lumbar HNP among adolescents, most patients with lumbar disc ailment in this age group might be underdiagnosed initially. Similarly, in our case study the patient was not diagnosed when medical opinion was sought after two months of persistent pain with radiculopathy to the right side toward big toe. The clinical characteristics of pediatric lumbar HNP are usually comparable to those seen in adults; however, one distinguishing feature is that up to 90% have a positive straight-leg raising test. The most common symptom is lumbar pain; limitation of lumbar motility and lassegue are the most common signs. The etiology, pathophysiology, and patterns of the scoliotic posture in cases secondary to HNP remain debated. It is highly recommended to do CT scan in cases of adolescent lumbar HNP to rule out apophyseal ring fracture; accurate diagnosis helps surgeon in planning the appropriate surgical intervention needed. Scoliosis secondary to lumbar disc herniation is observed occasionally, therefore, its clinical significance and pathophysiology are not well-established. However, it is well-recognized that children’s spines have superior adaptive capacity, which shields nervous tissue. An example of this could be scoliosis in patients with root compression, when they bend to the side contrary to the compression, causing an enlargement of the affected foramen and root release. It has been reported that 80% of the patients with disc herniation and scoliosis had the convexity on the side of the root compression. The MRI findings revealed that the scoliosis widened the foramen. Similarly, in our case report the X-ray depicted scoliotic deformity with convexity toward the right side. MRI is the best imaging technique to indicate disc herniation and eliminate other likelihoods in both children and adolescents. Surgical interventions, such as micro-endoscopy discectomy and percutaneous endoscopic lumbar discectomy, could achieve considerable pain relief and function improvement. Our case finding revealed that microscopic discectomy relieved the pain and improved the scoliosis. Conclusion: Lumbar disc herniation is a rare entity among both children and adolescent and may also result in scoliosis and lumbar pain with or without sciatica. Therefore, lumbar disc herniation in association with scoliosis need vigilant evaluation of signs and symptoms in addition to appropriate diagnostic imaging. Imaging has a vital role in the diagnosis of underlying disease state and helps in clinical management along with surgical planning. The appropriate treatment is discectomy.

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