Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Multi-access for the Diagnosis of Missed Upper Lumbar Disc Herniation

  • Lee, Dong-Yeob (Departments of Neurosurgery, Gimpo Airport Wooridul Spine Hospital) ;
  • Kim, Hyung-Seok (Departments of Radiology, Gimpo Airport Wooridul Spine Hospital) ;
  • Lee, Sang-Ho (Departments of Neurosurgery, Gimpo Airport Wooridul Spine Hospital)
  • Published : 2005.08.28
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Abstract

Herein, a case of missed upper lumbar disc herniation, diagnosed by thorough neurological examination, digital infrared thermographic imaging[DITI], and repeated magnetic resonance[MR] image study, is reported. A 36-year-old female presented with intractable leg pain on left anterior thigh. Although she underwent lumbar MR image at other hospital, she was misdiagnosed as acute sprain. Neurological examination suggested the possibility of upper lumbar disc herniation, which was confirmed by DITI, MRI, and selective root block. After operation, her leg pain was significantly improved. It should be considered that upper lumbar disc herniation might be misdiagnosed as an acute sprain, as in our case. A high index of suspicion based on thorough neurological examination is most important in such cases. Then, multi-access such as DITI, MR image, and selective block, base on thorough neurological examination, are warranted.

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References

  1. Albert TJ, Balderston RA, Heller JG, Herkowitz HN, Garfin SR, Tomany K, et al : Upper lumbar disc herniations. J Spinal Disord 6 : 351-359, 1993 https://doi.org/10.1097/00002517-199306040-00009
  2. Dinakar I : Protrusion of upper lumbar intervertebral discs (long-term follow-up of operated cases). J Indian Med Assoc 89 : 199-200, 1991
  3. Estridge MN, Rouhe SA, Johnson NG : The femoral stretching rest: A valuable sign in diagnosing upper lumbar disc herniations. J Neurosurg 57: 813-817, 1982 https://doi.org/10.3171/jns.1982.57.6.0813
  4. Kim JW, Lee SG, Jeong JH, Yoo CJ, Kim WK, Kim YB : Transfacet pedicle sparing approach in high lumbar disc herniarion. J Korean Neurosurg Soc 32 : 431-435, 2002
  5. Kim YS, Cho YE, Zhang HY : Thermatomes of the lumbosacral nerve roots. J Korean Neurosurg Soc 24: 33-46, 1995
  6. Kortelainen P, Puranen J, Koivisto E, Lahde S : Symptoms and signs of sciatica and their relation to the localization of the lumbar disc herniation. Spine 10: 88-92, 1985 https://doi.org/10.1097/00007632-198501000-00014
  7. Lee DY, Ahn Y, Lee SH: Lumbar disc herniation in adolescents: clinical and radiological characteristics. Korean J Spine 1: 353-357, 2004
  8. Nadler SF, Campagnolo DI, Tomaio AC, Stitik TP : High lumbar disc : Diagnostic and treatment dilemma. Am J Phys Med Rehabil 77: 538-544, 1998 https://doi.org/10.1097/00002060-199811000-00018
  9. Oh SJ: Clinical electromyography : Nerve conduction studies, ed 2. Williams and Wilkins 1993, pp26-38
  10. Pasztor E, Szarvas I : Herniation ofthe upper lumbar discs. Neurosurg Rev 4 : 151-157, 1981 https://doi.org/10.1007/BF01743641
  11. Sanderson SP, Houten J, Errico T, Forshaw D, Bauman J, Cooper PR : The unique characteristics of 'upper' lumbar disc herniations. Neurosurgery 55: 385-389, 2004 https://doi.org/10.1227/01.NEU.0000129548.14898.9B
  12. Takahashi Y, Takahashi K, Moriya H : Thermal deficit in lumbar radiculopathy. Correlation with pain and neurologic signs and its value for assessing symptomatic severity. Spine 19 : 2443-2449, 1994 https://doi.org/10.1097/00007632-199411000-00014