临床少见腰椎间盘突出症患者误诊情况分析OA

Objective To analyze the causes of clinical misdiagnosis of rare lumbar disc herniation(LDH)and the methods to correct misdiagnosis.Methods A retrospective analysis was conducted on the clinical data of 3 patients with rare LDH who were misdiagnosed with other diseases between August 2022 and August 2023.Results One patient presented with low back pain accompanied by movement disorders in both lower limbs for 7 d.The lumbar spine MRI examination suggested a suspected neoplastic lesion,with a higher possibility of being a schwannoma,and the initial diagnosis was intraspinal tumor in the lumbar spine.Lumbar 3 to lumbar 4(L3-L4)spinal canal exploration surgery was performed.During the operation,free intervertebral disc tissue was found posterolateral to the dural sac.Therefore,L3-L4 discectomy,spinal canal decompression,interbody bone graft fusion,and pedicle screw internal fixation surgery was performed.The intraoperative diagnosis was sequestered LDH,with a misdiagnosis duration of 4 d.Postoperative pathological examination showed degenerated intervertebral disc tissue.After 3 months of postoperative follow-up,the internal fixation position of the lumbar spine was good,and the patient's symptoms did not recur.One patient presented with intermittent colic pain in the left lower back for 9 d.B-ultrasound examination revealed renal colic and renal pelvic stone.After symptomatic treatment,the intermittent colic pain in the left lower back did not improve.Subsequently,lumbar CT and MRI examinations were performed to confirm the diagnosis of LDH,with a misdiagnosis duration of 9 d.Symptoms resolved following spinal balance restoration using fixed-point rotational reduction and comprehensive conservative treatment,and the symptoms disappeared.Follow-up for 1 month showed no recurrence.One patient presented with sudden left calf pain and difficulty in walking for 2 d.No osseous abnormalities were found in the left calf X-ray,leading to the initial diagnosis of gastrocnemius muscle spasm.At 3 d after symptomatic treatment,with no relief,the medical history was carefully inquired,lumbar MRI examination was performed,and the diagnosis was lumbar disc herniation.The misdiagnosis lasted 5 d.At 3 d after symptomatic treatment,the symptoms basically disappeared,and no recurrence was observed after 6 months of follow-up.Conclusion Lumbar disc herniation is relatively rare in clinical practice and has a relatively high rate of misdiagnosis.The main reasons for misdiagnosis include atypical symptoms that are easily confused with other diseases,insufficient differential diagnosis due to the limited scope of the initial department,and delays in imaging examinations or incorrect interpretation of imaging results.Through multidisciplinary consultations and targeted imaging examinations,clinical misdiagnoses can be effectively corrected.